- Molina Healthcare (Rochester, NY)
- …work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and ... Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in … more
- Cognizant (Albany, NY)
- …expectations. **What you need to have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...the medical necessity determinations to the Health Plan/ Medical Director based on the review of… 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
- CVS Health (NY)
- …Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... of residence.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS...setting. + A Registered Nurse that holds an active, unrestricted… more
- Guthrie (Binghamton, NY)
- Summary The Registered Nurse ( RN ) Utilization Management (UM) in collaboration with Care Coordination, Guthrie Clinic offices, other physician offices, and ... of patient status. 1. Collaborate and set standards with registered nurse ( RN ) case managers...Health System process improvement. + Denials Adjudication 1. Facilitate review of rejected medical claims … more
- Centene Corporation (New York, NY)
- …license; and a NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for ... beneficiary and the Network Provider. + Provides first level RN review for all outpatient and ancillary...necessity using appropriate criteria, referring those requests that fail review to the medical director for second… more
- Rochester Regional Health (Rochester, NY)
- …Safety. Required Licensure/Certification Active licensure in one of the following: + Preferred: Registered Nurse ( RN ) + Qualified: Licensed Practical ... Job Title: Injury Prevention Specialist ( RN )Department: Injury Prevention Location: Rochester General Hospital Hours...assessments and training on an ad hoc basis. + Review federal and state safety regulations to ensure program… more
- CDPHP (Latham, NY)
- …coding of risk adjustment eligible members. This position will have responsibility for review of medical records to identify accurate ICD-10 diagnosis codes, ... or CPC/CPC-A (Certified Coding Professional) required. If CCA or RN /LPN licensure, successful completion of AHIMA CCS/CCS-P or AAPC...of medical terminology, anatomy and physiology, and medical chart review required. + Knowledge of… 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
- Independent Health (Buffalo, NY)
- …with regulatory standards, clinical criteria, and member benefit contract. **Qualifications** + Registered Nurse ( RN ) with active, current, unrestricted NYS ... Clinical Reviewer will be responsible for the collection and review of medical records specific to quality...such as Outlook, Word, Excel, and specific clinical and claims platforms. + Possess initiative, attention to detail, and… more