- Cognizant (Albany, NY)
- …to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with managed ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and… more
- Centene Corporation (New York, NY)
- …State Licensure required or + LVN - Licensed Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure ... appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best… more
- Catholic Health (Buffalo, NY)
- …finance, business management, operational analysis, information systems or related field + Registered Nurse with a four (4) year degree and Unrestricted ... role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical ...NYS RN license, preferred + Holds, or will obtain within… more
- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals ... include but not limited to: + Receives, manages and provides clinical reviews and/or submissions as required by contractual or regulatory requirements.… more
- Evolent (Albany, NY)
- …to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
- Independent Health (Buffalo, NY)
- …regulatory standards, clinical criteria, and member benefit contract. **Qualifications** + Registered Nurse ( RN ) with active, current, unrestricted NYS ... Trustworthy, Collaborative and Accountable. **Essential Accountabilities** + Thoroughly investigate clinical appeals and complaints/grievances utilizing appropriate internal… more
- Independent Health (Buffalo, NY)
- …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... Coder (CIC), Registered Health Information Management Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Clinical Documentation… more
- Rochester Regional Health (Rochester, NY)
- …Support - American Heart Association (AHA)American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - New York State Education ... acute hospital care experience + Licensed in New York State as a Registered Nurse PREFERRED QUALIFICATIONS: + Case Management or Utilization Management… more
- Mount Sinai Health System (New York, NY)
- …for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission). ... **Job Description** ** RN /Case Manager MSH Case Management PT Days** The...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the… more
- Elderwood (Cheektowaga, NY)
- Salary $38 - $49.50 per hour Overview Are you a Registered Nurse ( RN ) with Medicare experience? Do you consider yourself an expert in assessment and ... of Benefits Program + Increased Tuition Reimbursement Program for Clinical Tracks + Shift Differentials + Full Benefits Package... - MDS Coordinator - Qualifications: + Licensed Professional Nurse ( RN licensure preferred) with current license… more