• RN Medicare Compliance…

    Sedgwick (Albany, NY)
    …Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance RN Medicare Compliance - Proactive Reduction Outreach **PRIMARY PURPOSE** ... review, and analysis and interpretation of interventions for the preparation of Medicare Set-Aside allocations. **ARE YOU AN IDEAL CANDIDATE?** We are looking for… more
    Sedgwick (11/12/25)
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  • Medicare Annual Wellness Visit…

    SUNY Upstate Medical University (Syracuse, NY)
    …Position Summary: Upstate University Medical Associates at Syracuse Inc. (UUMAS) is seeking a Registered Nurse ( RN ), or Certified Nurse Specialist (CNS), ... resources. Ensure accurate coding and documentation to support quality initiatives and Medicare compliance . Work closely with clinical teams across seven Primary… more
    SUNY Upstate Medical University (08/28/25)
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  • Medical Investigator I/II ( RN Required)

    Excellus BlueCross BlueShield (Rochester, NY)
    …investigating and remediating allegations of FWA while adhering to compliance and regulatory requirements. Primary activities include substantiating referrals, case ... accuracy of information provided to providers, regulators, law enforcement, Legal, Compliance and outside counsel. Prepares cases for prosecution, civil settlement,… more
    Excellus BlueCross BlueShield (09/17/25)
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  • Case Manager, Medicaid Long Term Support Program

    MVP Health Care (Tarrytown, NY)
    …York** **Qualifications you'll bring:** + Current New York State Licensure as a Registered Nurse required. + Certification in Case Management required within 24 ... managers, care coordinators, and providers to ensure integrated, person-centered care. + Compliance & Quality: Ensure adherence to Medicaid, Medicare , and… more
    MVP Health Care (11/12/25)
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  • Clinical UM Nurse

    CenterWell (Albany, NY)
    …**Use your skills to make an impact** **Required Qualifications** + Must be a licensed Registered Compact Nurse license ( RN ) with no disciplinary action and ... and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent...a related field + Health Plan experience + Previous Medicare /Medicaid Experience a plus + Call center or triage… more
    CenterWell (11/12/25)
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