- Molina Healthcare (Syracuse, NY)
- JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals ... health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted… more
- Rochester Regional Health (Rochester, NY)
- …BLS - Basic Life Support - American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - New York State Education Department ... Job Title: Registered Nurse I Department: Utilization Management...UM review findings, initiate and 1st, 2nd, and/or arbitration appeals as needed. Document in all areas that an… more
- Elevance Health (New Hyde Park, NY)
- ** Nurse Appeals - Litigation & Legal...Review requests. + Acts as a resource for both clinical and non- clinical teams, by managing and ... necessary and is dependent on court hearing schedules. The ** Nurse Appeals - Litigation & Legal Support**...would provide an equivalent background. + Current active unrestricted RN license to practice as a health professional within… more
- Evolent (Albany, NY)
- …to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
- BronxCare Health System (Bronx, NY)
- …by the department physician advisors and clinical staff. Qualifications - NYS Registered Nurse required - The Appeal Manager must have excellent verbal and ... and electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical ...preferred. -The Appeal Manager should have experience as a nurse in acute care clinical setting who… more
- Crouse Hospital (Syracuse, NY)
- …requirements and contractual agreements. Care Coordination Manager Requirements: + Licensed as a Registered Nurse in New York State + Bachelor's degree + Five ... Coordination 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
- Molina Healthcare (Albany, 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 ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review,...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… 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 PT Days** The...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the… more
- Catholic Health (Buffalo, NY)
- …is vital. Responsibilities: EDUCATION + Bachelor of Science Nursing (BSN) degree + Registered Nurse with a current New York State license CERTIFICATION + ... mentoring Utilization Review, Clinical Documentation Integrity and Clinical Denials and Appeals teams. They ensure...payers strongly preferred + Must maintain New York State RN license EXPERIENCE + Minimum of eight (8) years… more
- Guthrie (Binghamton, NY)
- …needed for patient that have arrived without orders. Prepare educational materials for the RN Nurse Navigator for Chemo Education Visits per the instruction and ... of coverage of ordered medications. + Coordinate and complete appeals for denials as needed + Monitor and Review...offices and for DBL office as needed Coverage for RN Nurse Navigator + Coordinate and facilitate… more
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