- 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
- Excellus BlueCross BlueShield (Rochester, NY)
- …with Provider Relations, explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or otherwise ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and...Mandates. + May be responsible for pricing, coding, researching claims to ensure accurate application of contract benefits and… 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
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