- Molina Healthcare (Syracuse, NY)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... **Job Duties** + Performs clinical/ medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which… more
- CP Unlimited (Carmel, NY)
- Registered Nurse Type of Position Full...semiannual basis or as indicated. + Coordinate with the Medical Case Manager Counselors (MCMC) to ensure medical ... 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… 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...the timeframe assigned C. REQUIREMENTS: 1. Maintain current NYS Registered Nurse license - Graduation from an… more
- Public Consulting Group (Albany, NY)
- …sector. To learn more, visit www.publicconsultinggroup.com . PCG is currently seeking a qualified Registered Nurse to perform as a Case Manager. The Case Manager ... Proven working experience in case management, including as a nurse , medical , mental health care manager or...plans. + Current license, certification or registration as a Registered Nurse or Social Worker **Working Conditions**… more
- Molina Healthcare (Albany, NY)
- …to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. ... nursing experience with broad clinical knowledge. + Five years experience conducting medical review and coding/billing audits involving professional and facility… 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, ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/ medical reviews of… more
- Guardian Life (Albany, NY)
- …providing comprehensive medical reviews and analysis of long-term disability claims . The RN Clinical Consultant identifies restrictions, limitations and ... duration impacting functional capacity based on medical data, to assist the Claim Managers...The RN Clinical Consultant reviews long-term disability claims to determine the impact of claimants' medical… more
- MetLife (Oriskany, NY)
- …quarterly meetings with the Vocational resource and Account team member. * Participate in claim review meetings as requested by the customer. * Utilize tools ... for meetings Key Responsibilities: * Independently assess, analyze and render appropriate claim decisions pursuant to certificates on all claims . * Compare… more
- Guthrie (Binghamton, NY)
- …cases. Assists departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. ... services regarding admissions, case management, discharge planning and utilization review . Responsibilites: Reviews admissions and service requests within assigned… more
- Trinity Health (Syracuse, NY)
- …meeting regulatory requirements for reporting to the FDA pursuant to the Safe Medical Device Act. **PROPERTY LOSS PREVENTION AND CLAIMS REPORTING:** Collaborates ... standing and walking. **WORK CONTACT GROUP:** All services, employees, medical staff, patients, visitors, vendors, various regulatory and professional agencies.… more
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