- Molina Healthcare (Rochester, NY)
- JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring ... hospital setting, including at least 1 year of utilization review , medical claims review...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Rochester, NY)
- …work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and ... Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in … more
- Centene Corporation (New York, NY)
- … Licensure as well as a State Issued NY ID.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all outpatient ... beneficiary and the Network Provider. + Provides first level RN review for all outpatient and ancillary...necessity using appropriate criteria, referring those requests that fail review to the medical director for second… more
- Cognizant (Albany, NY)
- …role expectations. **What you need to have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and utilization ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...the medical necessity determinations to the Health Plan/ Medical Director based on the review of… 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
- CVS Health (Albany, NY)
- …Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... virtual** **training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS...setting. + A Registered Nurse that holds an active, unrestricted… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …with Provider Relations, explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or otherwise ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and...Mandates. + May be responsible for pricing, coding, researching claims to ensure accurate application of contract benefits and… more
- Independent Health (Buffalo, NY)
- …with the core components of the client centric delivery model. **Qualifications** + Registered Nurse ( RN ) with active, current, unrestricted NYS license ... database. + Provide high quality, professional utilization management services: ( medical necessity review for Prior Authorization, pre-certification, and… more
- Rochester Regional Health (Rochester, NY)
- …Safety. Required Licensure/Certification Active licensure in one of the following: + Preferred: Registered Nurse ( RN ) + Qualified: Licensed Practical ... Job Title: Injury Prevention Specialist ( RN )Department: Injury Prevention Location: Rochester General Hospital Hours...assessments and training on an ad hoc basis. + Review federal and state safety regulations to ensure program… 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 ... on workplace flexibility. **Position Purpose:** The Clinical Quality Assurance RN will work in various capacities to review...order to ensure that all components of the Member's medical record are completed with quality standards and accuracy… more
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