• Registered Nurse - Clinical…

    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
    Cognizant (10/09/25)
    - Related Jobs

  • Clinical Review Clinician - Appeals

    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
    Centene Corporation (10/08/25)
    - Related Jobs

  • Clinical Denials and Appeals…

    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 (10/01/25)
    - Related Jobs

  • Utilization and Appeals Manager

    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
    Catholic Health Services (07/24/25)
    - Related Jobs

  • Appeals Nurse

    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
    Evolent (10/11/25)
    - Related Jobs

  • Clinical Reviewer

    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 (10/07/25)
    - Related Jobs

  • Inpatient Clinical & Coding Specialist…

    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
    Independent Health (10/04/25)
    - Related Jobs

  • Care Facilitator- Canton-Potsdam Hospital, Potsdam

    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
    Rochester Regional Health (09/19/25)
    - Related Jobs

  • RN /Case Manager-MSH-Case…

    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
    Mount Sinai Health System (09/23/25)
    - Related Jobs

  • RN - MDS Coordinator

    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
    Elderwood (10/04/25)
    - Related Jobs