- Molina Healthcare (Rochester, NY)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... schedule) Looking for a RN with experience with appeals, claims review , and medical coding....clinical/ medical reviews of retrospective medical claim reviews, medical claims and… more
- CDPHP (Latham, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... coordinating with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care initial… more
- Centene Corporation (New York, NY)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review ... and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review and… more
- Constructive Partnerships Unlimited (Manhattan, NY)
- …Interdisciplinary Treatment Team to ensure that all team members are aware of all medical conditions and care. 8. Review reports daily to ensure timely, ... in all corporate compliance investigations and reviews. SUPERVISES: Nurse Educators Nurse Case Managers (NCM) Medical Case Manager Counselors (MCMC) more
- Northern Rivers Family Services (Troy, NY)
- …an NPI. Claims processing functions also require the NPI of nurse practitioners and physicians. + Federal Drug Enforcement Administration (DEA)number - issued by ... Nurse Practitioner - Psychiatry Job Details Job Location...and education to staff + Prescribe medications, monitor, and review of drug regimen for enrolled individuals + Participate… more
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- About The Role Brighton Health Plan Solutions (BHPS) provides Utilization Review / Medical and Case Management services for Group Health and Workers' Compensation ... and other Casualty clients. The Workers' Compensation Nurse Case Reviewer collaborates with medical care...+ Collaborates with workers' compensation patients, employers, providers, and claims adjusters to coordinate medical and disability… more
- Humana (Albany, NY)
- …action. + Complete medical record reviews + Assess discharge plans + Review and extract information from claims + Complete documentation for Quality Reviews ... the appropriate courses of action. The Utilization Management Behavioral Health Nurse 2 completes medical record reviews from medical records sent from… more
- Travelers Insurance Company (Melville, NY)
- …Utilize evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... evaluating, reserving, negotiating and resolving assigned serious and complex Specialty claims . Provides quality claim handling throughout the claim… more
- Centene Corporation (Queens, NY)
- …terminology such as ICD 10 codes, medical abbreviations, medications. Experience in medical records review , claims processing or utilization and case ... Quality Assurance RN will work in various capacities to review , monitor and train staff in the Long Term...order to ensure that all components of the Member's medical record are completed with quality standards and accuracy… more
- Molina Healthcare (Albany, NY)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… more
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