- Travelers Insurance Company (Albany, 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
- CDPHP (Albany, 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
- 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
- Public Consulting Group (Albany, NY)
- …and on a team. + Proven working experience in case management, including as a nurse , medical , mental health care manager or a related job + Excellent knowledge ... www.publicconsultinggroup.com . PCG is currently seeking a qualified Registered Nurse to perform as a Case Manager. The Case...be responsible for assisting enrollees of a publicly administered Medical Fund on behalf of a state agency. The… more
- Evolent (Albany, NY)
- …other clinicians who review the appeal, the claims department to review provider post-service claims for medical necessity, and managers for ... the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact as part of… more
- Brighton Health Plan Solutions, LLC (New York, 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
- Molina Healthcare (Syracuse, 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
- CP Unlimited (Carmel, NY)
- Registered Nurse Type of Position Full time Search Location(s) Carmel, NY, Fishkill, NY, Garrison, NY, Poughkeepsie, NY, Yonkers, NY Apply Now ... (https://phe.tbe.taleo.net/phe03/ats/careers/v2/applyRequisition?org=CPOFNYS&cws=45&rid=6353) Job Brief The Registered Nurse shall provide health related services to individuals who… more
- BronxCare Health System (Bronx, NY)
- …(according to the NPSG), intake screening of patient, pre-visit planning (if applicable), review of medical record to determine visit requirements such as HEIDS ... Overview Licensed Practical Nurse : Under the direct supervision of a physician...analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality… more
- FlexStaff (Poughkeepsie, NY)
- **Req Number** 153761 FlexStaff is looking for a Registered Nurse Case Manager. Coordinate the delivery of health care services for persons receiving services as ... semiannual basis or as indicated. 3. Coordinate with the Medical Case Manager Counselors (MCMC) to ensure medical...available and administered by AMAP-certified staff as ordered. 16. Review and edit the medication record to ensure the… more