• RN Clinical Appeals…

    Molina Healthcare (Yonkers, 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
    Molina Healthcare (10/04/25)
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  • Clinical Denials and Appeals…

    Catholic Health (Buffalo, NY)
    …finance, business management, operational analysis, information systems or related field + Registered Nurse with a four (4) year degree and Unrestricted ... role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical ...NYS RN license, preferred + Holds, or will obtain within… more
    Catholic Health (10/01/25)
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  • Medical Claim Review Nurse ( RN )

    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
    Molina Healthcare (09/06/25)
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  • RN - MDS Coordinator

    Elderwood (Cheektowaga, NY)
    Salary $38 - $49.50 per hour Overview Are you a Registered Nurse ( RN ) with Medicare experience? Do you consider yourself an expert in assessment and ... of Benefits Program + Increased Tuition Reimbursement Program for Clinical Tracks + Shift Differentials + Full Benefits Package... - MDS Coordinator - Qualifications: + Licensed Professional Nurse ( RN licensure preferred) with current license… more
    Elderwood (10/04/25)
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  • Director of Care Coordination ( RN )

    Catholic Health Services (West Islip, NY)
    …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
    Catholic Health Services (07/18/25)
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  • RN /Case Manager-MSH-Case…

    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 PT Days** The...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the… more
    Mount Sinai Health System (09/23/25)
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  • RN Case Manager, Inpatient

    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
    Memorial Sloan-Kettering Cancer Center (10/01/25)
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  • Case Manager RN

    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
    Bassett Healthcare (10/03/25)
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  • Community Health Assessment Field Nurse…

    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
    Excellus BlueCross BlueShield (09/27/25)
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  • Clinical Denials Specialist

    UHS (Binghamton, NY)
    …(5) years of experience in acute/tertiary facility. + Minimum Required: NYS Licensed Registered Nurse Preferred: + Bachelor's of Science in Nursing with three ... Position OverviewUnited Health Services (UHS) is seeking a proactive and analytical Clinical Denials Specialist to join our Revenue Cycle team. In this vital role,… more
    UHS (09/09/25)
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