- Molina Healthcare (Albany, NY)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying ... cost-effective member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are Monday-Friday 8:00am- 5:00pm PST. This… more
- Molina Healthcare (Rochester, NY)
- JOB DESCRIPTION **Job Summary** The Care Review Clinician (RN) provides support for clinical member services review assessment processes. Responsible for ... Hospital experience. Candidates with MCO experience are highly preferred. The Care Review Clinician must be able to work independently in a high-volume environment.… more
- Actalent (New York, NY)
- …nursing experience. + Proficiency with Microsoft Office applications. + Experience with utilization or appeals review . + Knowledge of InterQual criteria. + ... determine if medical necessity criteria are met. Responsibilities + Review clinical data to determine claim payment based on...or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to… more
- Molina Healthcare (Albany, NY)
- …who must be licensed for the state they reside This role will be doing Utilization review for our Ohio Medicaid population, looking for clinicians with strong ... 8 AM to 5 PM EST This is a Remote position, home office with internet connectivity of high...DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are… more
- Molina Healthcare (Rochester, NY)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of ... on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member… more
- CenterWell (Westbury, NY)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... **Branch Location** : Westbury, NY **This is not a remote or work-from-home position. This position requires you to...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more
- Albany Medical Center (Albany, NY)
- …Licensure, Certification & Registration: + Must hold a current NYS Registered Nurse license. Experience: + 7-10 years of experience in nursing, involving ... on-site as the work cannot be done from a remote location. + All job requirements listed indicate the...changes in work efficiently and effectively. Support implementation and utilization of clinical nursing research. Promote the use by… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources. ... consistent and quality health care services. Examples may include: Utilization Management, Quality, Behavioral Health, Pharmacy, Registered Dietitian and Respiratory… more
- Veterans Affairs, Veterans Health Administration (Binghamton, NY)
- …coordinated care delivery model. Coordinates with the patient care team to review clinic appointment availability ( utilization ) to ensure that clinic schedules ... the phone. When consults are in a "scheduled status", the Advanced MSA will: Review the Vista Image Display to determine, If the records have previously been… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …can be provided by KPH upon date of discharge. This is not a remote opportunity and will be based in Watertown or Camillus, NY. **Responsibilities** **Job ... Responsible for planning and implementation of services to drive utilization of the Kinney Home Services program. + Proactively...the program. + Attends discharge meetings as necessary to review areas of concern and create plans for resolution.… more