- Molina Healthcare (Albany, NY)
- … decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making...these guidelines. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- Crouse Hospital (Syracuse, NY)
- …requirements and contractual agreements. Manager, Care Coordination Requirements: + Licensed as a Registered Nurse in New York State + Bachelor's degree + Five ... hiring a Manager who is responsible for providing day to day management of the RN Care Managers in the department. Pay Range: $95,000 plus based on education and… more
- Intermountain Health (Albany, NY)
- **Job Description:** The RCO Audit & Appeals RN Consultant is responsible for consulting on clinical Appeals and Audits for Intermountain Health. The ... Audit/ Appeals RN Consultant will execute clinical audits of...institution. Education is verified + Current licensure as a registered nurse required. + Experience in Microsoft… more
- Molina Healthcare (Rochester, NY)
- …hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing ... resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical … more
- Catholic Health Services (West Islip, NY)
- …(BSN) degree required. Master of Science degree strongly preferred. Licensure: New York Registered Nurse ( RN ) License & Registration. Certification: Care ... not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals , Managed Care and Revenue Cycle and Patient Access departments to ensure… more
- Mount Sinai Health System (New York, NY)
- …for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission). ... **Job Description** ** RN /Case Manager MSH Case Management FT Days** The...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the… more
- Mount Sinai Health System (New York, NY)
- …for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission). ... **Job Description** RN /Case Manager Mount Sinai West FT Days 8a-4p...with physicians and managed care companies on concurrent denial appeals 5. Communicates clinical information to the… more
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …appeals and acquire authorizations for treatment **Key Qualifications:** + Current NYS Registered Nurse License/Registration and BSN preferred + At least 2-3 ... Kettering Institute, scientists across MSK collaborate to conduct innovative translational and clinical research that is driving a revolution in our understanding of… more
- Bassett Healthcare (Cooperstown, NY)
- …in a healthcare setting, preferred Licensure/Certifications: + Current NYS licensure as a Registered Professional Nurse , if applying as a nurse , required ... of life possible. What you'll do The Case Manager RN supports the physician and interdisciplinary team in facilitating...with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …the use of medical and health care services for members. The SN CHA Nurse may also perform other technical and administrative tasks essential to the efficient ... expert and occasionally works directly with the operation and clinical staff to resolve issues and escalated problems. +...other functions as assigned by management. Minimum Qualifications: + RN with valid and current NYS Nursing Licensure. +… more