- 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
- 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
- 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
- Excellus BlueCross BlueShield (Rochester, NY)
- …case planning and research, conducting onsite or desk audits, clinical reviews of medical records to ensure correct billing of services and appropriateness of care, ... Level I + Functions as a clinical reviewer of medical records, researching and investigating complex medical ...and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. +… 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
- WMCHealth (Poughkeepsie, NY)
- …related to medical staff PI + Screens cases to identify issues for physician review , using criteria established by the medical staff and the NYS DOH. + ... a potential lawsuit, etc.) and alerts the department director, medical staff leadership, and claims manager. +...+ BSN preferred. LICENSES/CERTIFICATIONS Licensed in NYS as a Registered Professional Nurse OTHER + If applicable,… 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
- CDPHP (Latham, NY)
- …on nationally recognized criteria and CDPHP policies, and procedures. QUALIFICATIONS: + Registered Nurse with a current New York State license required. ... to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the...years of acute care experience is required as a Registered Nurse . + Minimum of two (2)… more
- CDPHP (Latham, NY)
- …invites you to be a part of that experience. The Medicaid Special Programs Registered Nurse Case Manager is responsible and accountable for coordinating the care ... and cost outcomes. In addition, the Medicaid Special Programs Registered Nurse Case Manager is responsible and...medical services across the health care continuum. The RN Case Manager will demonstrate strengths in working independently… more
- Constructive Partnerships Unlimited (Brooklyn, NY)
- …the Residence Manager, and reports all medical issues/ injuries to the registered nurse and follows protocols for notification. 13. Performs variety of ... reports and maintaining database of consumer health information after review and signed by the RN . +...+ Performs all other duties as assigned by the registered nurse . II. POSITION REQUIREMENTS A. Qualifications… more