- Cognizant (Albany, NY)
- …you need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and… more
- Catholic Health (Buffalo, NY)
- …finance, business management, operational analysis, information systems or related field + Registered Nurse with a four (4) year degree and Unrestricted ... based on role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical Supervisor is responsible for the people, carrying out… more
- Independent Health (Buffalo, NY)
- …standards, clinical criteria, and member benefit contract. **Qualifications** + Registered Nurse (RN) with active, current, unrestricted NYS license ... Trustworthy, Collaborative and Accountable. **Essential Accountabilities** + Thoroughly investigate clinical appeals and complaints/grievances utilizing appropriate internal… more
- Molina Healthcare (Rochester, NY)
- …and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... resource for utilization management, chief medical officers, physicians and member/provider inquiries/ appeals . * Provides training and support to clinical peers.… more
- Molina Healthcare (Buffalo, NY)
- …resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing clinical knowledge… more
- FlexStaff (Brooklyn, NY)
- …in patient care and staff support. Requirements: + Active New York State (NYS) Registered Nurse (RN) License. + Strong knowledge of Certified Home Health Agency ... + Contribute to continuous performance improvement initiatives. + Prepare and manage appeals processes. + Track and manage grievances. + Analyze patient satisfaction… more
- Garnet Health (Middletown, NY)
- … Documentation Specialist (CCDS) credentialed * Current license to practice as a Registered Professional Nurse in New York State required. Physical Requirements: ... to make your career home with us as a CLinical Documnetaion Specialist on our CDI team at/in Garnet...day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement and evaluate… more
- 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 ... after hire. + At least 3 years of recent clinical and Case Management experience. Experience working in a...maintain cost-effectiveness and manage Medical Loss Ratio (MLR). + Appeals & Denials: Participate in the appeals … more
- Rochester Regional Health (Rochester, NY)
- …acute hospital care experience + Licensed in New York State as a Registered Nurse PREFERRED QUALIFICATIONS: + Case Management or Utilization Management ... Heart Association (AHA)American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - New York State Education Department (NYSED)New… more
- 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