- Molina Healthcare (Yonkers, NY)
- **JOB DESCRIPTION** For this position we are seeking a (RN) Registered Nurse who must be licensed for the state they reside This position will support Medical Review ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… more
- Northern Rivers Family Services (Troy, NY)
- …collaborate with county and community partners, and participate in any quality audit and utilization review + Provide on-site/community based/home visits, ... Nurse -Psychiatric NP Job Details Job Location Rensselaer-PCFC -...$80.00 - $90.00 Hourly Travel Percentage None Job Category Nurse Description Our Assertive Community Treatment (ACT) programs are… more
- Elderwood (Lake Placid, NY)
- Salary $74,000 to $96,525 / year Overview RN - MDS Nurse Assessor Pay Rate Range:$74,000 - $96,525 / year (Earn more with experience!) NEW:Gas Allowance Benefit for ... Full-time and Part-time positions Are you a Registered Nurse (RN) with Medicare experience? Do you consider yourself an expert in assessment and reimbursement… more
- Molina Healthcare (Yonkers, NY)
- …decision making pertinent to clinical experience + Documents clinical review summaries, bill audit findings and audit details in the database + Provides ... of payment decisions. + Serves as a clinical resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Mercy Flight Central (Rome, NY)
- FLIGHT NURSE Rome, NY (http://maps.google.com/maps?q=660+Hangar+Road+Rome+NY+USA+13441) * Air Medical Apply Description Job Summary: Utilizing ICU/ED hospital ... and modification of care plan throughout patient transfer. + Utilization of Medical control for deviations of MFC Standards...years ED or ICU experience + Certified Flight Registered Nurse (CFRN) within one year of hire + Maintain… more
- Elderwood (Liverpool, NY)
- …$29.00 - $37.70 / hourly Overview Elderwood at Liverpool is seeking a Licensed Professional Nurse to join our clinical team as a LPN MDS Nurse Assessor. LPNs, ... right skill set, will be considered as well. MDS Nurse Assessor - Position Overview: + An MDS ...State requirements, and facility policies. + Actively participate in utilization management processes, including PDPM and state case mix… more
- Elderwood (Hamburg, NY)
- Salary Up to $49.50 / Hour Overview Elderwood at Hamburg is seeking a Registered Nurse (RN) to join our clinical team as a MDS Nurse . Position Overview: + An MDS ... (Minimum Data Set) nurse , or nurse assessment coordinator, collects and...State requirements, and facility policies. + Actively participate in utilization management processes, including PDPM and state case mix… more
- Healthfirst (NY)
- …gaps in care, and implement performance improvement strategies using clinical, utilization , and quality data + Partner with departments across Healthfirst, including ... behavioral health best practices + Ensures all NY state and federal compliance, audit and regulatory requirements are met + Perform other duties as necessary or… more
- BronxCare Health System (Bronx, NY)
- …the department's leadership develop strategies for denial prevention, improved utilization management, documentation of medical necessity and identify patterns and ... such as IPRO, The Joint Commission, Regional and Medical Audit Contractors, and other licensing, accrediting, or review agencies....electronic database system. The Appeal Manager should be a nurse who has 3-5 years or more of experience… more
- Rochester Regional Health (Rochester, NY)
- …Level II + Manages larger and more complex caseloads with effective service utilization and independent decision-making. + Acts as a mentor and informal leader, ... improvement ideas, participates in problem-solving, and consistently achieves positive audit outcomes. + Serves as a clinical role model,...of 2 years of home care experience. + Registered Nurse license in New York State. + Valid NYS… more