- Excellus BlueCross BlueShield (Rochester, NY)
- …time-service standards required by the Company. + Evaluates Insured's condition through review of field assessments, medical records, etc. Determines benefit ... with Insured, Insured's family, care providers, and monitoring of claim submission and processing. All work is directed under...care customer service. + Must have the ability to review and interpret medical records and assessments… more
- Constructive Partnerships Unlimited (Brooklyn, NY)
- …medical issues with VP of Nursing, Nurse Administrator, Registered Nurse ( RN ), and Medical Coordinators2. Maintains medical records, including ... health recordse. As directed by the VP of Nursing/ Nurse Administrator debrides hard copy of medical ...stationery supplies.23. Perform data entry tasks accurately and efficiently. Review data for deficiencies or errors.24. Assist with special… more
- BronxCare Health System (Bronx, NY)
- …Licensed Practical Nurse : Under the direct supervision of a physician and/ or Registered Nurse , participates in the application of the nursing process to an ... (according to the NPSG), intake screening of patient, pre-visit planning (if applicable), review of medical record to determine visit requirements such as HEIDS… more
- CVS Health (Albany, NY)
- …+ 3+ years of clinical experience in a healthcare setting. + 2+ years as a Registered Nurse ( RN ) or License Practical Nurse / License Vocational ... Nurse . + Active, current, and unrestricted RN /LVP/LPN license in the state of residence. + Proficiency in Microsoft Office Suite (Outlook, Excel) and ability to… more
- Humana (Albany, NY)
- …timeframe **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) Compact license, with no disciplinary action ... us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the...Health Provider Disputes based on the business need + Review and extract information from claims +… more
- BronxCare Health System (Bronx, NY)
- …and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate preferred . ... collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement… more
- Terumo Medical Corporation (New York, NY)
- …Date: Nov 13, 2025 Req ID: 5263 Location: New York, NY, US Company: Terumo Medical Corporation Department: TIS Sales - New York Metro Terumo Medical Corporation ... (TMC) develops, manufactures, and markets a complete, solutions-based portfolio of high-quality medical devices used in a broad range of applications for numerous… more
- Catholic Health Services (Melville, NY)
- …The ProFee CDS will focus on pre-visit provider support, post-visit provider review , and collaboration and education with providers. Pre-visit provider support - ... indicators + Validation of data-driven suspect diagnoses Post-visit provider review - Perform post-visit reviews focused on what is...other chronic conditions that are addressed as part of medical decision making and the treatment plan + Assesses… more
- Mount Sinai Health System (New York, NY)
- …The Senior Risk Manager supports the Risk Management staff on how best to review risk management data, conduct Root Cause Analysis, and comply with risk management ... to develop educational plans for instructing staff about the medical center's activities and the daily administration of its...to the Risk Management staff on how best to review risk management data, conduct Root Cause Analysis, and… more
- Intermountain Health (Albany, NY)
- …and collaborates with Clinical Documentation Integrity (CDI) Registered Nurses ( RN ) and Intermountain Physician Advisors to review complex facility ... Diseases ICD-10 and Diagnosis Related Groups (DRG) codes for claims concurrently while a patient is in a hospital....reviews while patients are hospitalized. It aids in the review of quality measures including Patient Safety Indicators and… more