- Cognizant (Albany, NY)
- …need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or 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
- Centene Corporation (New York, NY)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... **Hours: 8:30am-5pm EST Monday - Friday.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals...Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact… 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)
- …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
- 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
- Mount Sinai Health System (Long Island City, NY)
- …field **Experience Requirements** 5 years of Case Management and 6 years of clinical nurse experience. Previous supervisory experience in Case Management or a ... field. **Licensing and Certification Requirements (if applicable)** Licensed as a registered nurse , Issuing Agency: Department of Health/Office of Professions… more
- Bassett Healthcare (Cooperstown, NY)
- …in a healthcare setting, preferred Licensure/Certifications: + Current NYS licensure as a Registered Professional Nurse , if applying as a nurse , required ... facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and… 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