- Molina Healthcare (Buffalo, NY)
- …At least 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports ... DESCRIPTION **Job Summary** Provides support for medical claim and internal appeals review activities -...or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must… more
- New York State Civil Service (Endicott, NY)
- NY HELP Yes Agency Insurance Fund, State Title Registered Nurse 2 - Medical Care (NY HELPS) Occupational Category Health Care, Human/Social Services Salary ... City Endicott State NY Zip Code 13760 Duties Description Registered Nurse 2 ( Medical Care)...limited to:* Perform claimant outreach* Perform catastrophic and/or high-cost claims management* Review and process PARS for… more
- CP Unlimited (Carmel, NY)
- Registered Nurse Type of Position Full...semiannual basis or as indicated. + Coordinate with the Medical Case Manager Counselors (MCMC) to ensure medical ... NY, Yonkers, NY Apply Now (https://phe.tbe.taleo.net/phe03/ats/careers/v2/applyRequisition?org=CPOFNYS&cws=45&rid=6353) Job Brief The Registered Nurse shall provide health related services… more
- Molina Healthcare (Albany, NY)
- For this position we are seeking a ( RN ) Registered Nurse who...for a RN with experience with appeals, claims review , and medical coding. ... authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted… more
- Sedgwick (Albany, NY)
- …providers to support the claim request and documents decision rationale. + Completes medical review of all claims by reviewing medical documentation ... clinical evaluations on claims that require additional review based on medical condition, client requirement,... management of claims including comprehension of medical terminology and substantiating claim decisions. **ADDITIONAL… more
- Centene Corporation (New York, NY)
- …establish processes to respond to ICD-10 coding changes and its effect on inpatient claims payment. Chart review will include DRG pre-payment review , ... hospital readmission review and outlier payment review . + Analyze moderately complex health care information; reviews...requirements are adhered to for the appropriate handling of medical necessity, claims denials, and bundling issues.… more
- Highmark Health (Albany, NY)
- …+ 1-3 years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related ... rejection and the proper action to complete the retrospective claim review with the goal of proper...Review process includes a review of medical documentation, itemized bills, and claims data… more
- Trinity Health (Syracuse, NY)
- …strongly preferred). + Master's degree preferred. + Certification (CPHRM) is preferred. + Registered Nurse preferred. + Ideally, the candidate will have 3-5 ... for the overall patient safety and clinical risk management functions related to review and response to reported events. Responds to crisis situations that have… more
- Catholic Health Services (Smithtown, NY)
- …coding and billing of resident care services to maximize reimbursement. + Claim Review : Review and analyze submitted claims for accuracy and identify ... care center; 296-bed not-for-profit community hospital and a 60,000 square foot medical office building. Our nurses, physicians and support staff are devoted to… more
- Capgemini (New York, NY)
- …ICH E2 (E2A-E2F). + Direct experience with ICSR processing: intake, triage, medical review , causality assessment (WHO-UMC, Naranjo), MedDRA coding, narrative ... analysis. + Knowledge of signal detection methods (statistical/data mining, literature review , clinical judgment). + Bachelor's in life sciences, pharmacy, nursing,… more