- Catholic Health Services (Melville, NY)
- …why Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews ... payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as required.… more
- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and ... to best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely tracking and trending of all denials… more
- Molina Healthcare (Yonkers, NY)
- …Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training, leadership and mentoring for less ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct...Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. +… more
- Mount Sinai Health System (New York, NY)
- …as per department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials + Tracking status ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...+ Requests or provides Medical Records as required for appeals , On / Off-site Insurance reviews + Implements… more
- Molina Healthcare (NY)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will… more
- Mount Sinai Health System (New York, NY)
- …homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager or a minimum of 3-5 years? experience as a ... **Job Description** **RN/Case Manager MSH Case Management FT Days** The Case...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- Mount Sinai Health System (New York, NY)
- …homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager or a minimum of 3-5 years? experience as a ... **Job Description** **RN/Case Manager Inpatient Mount Sinai West FT Days 8a-4p...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- Sanofi Group (Albany, NY)
- **Job Title:** Field Reimbursement Manager Tzield- Northeast Region **Location:** Remote **About the Job** The individual in this role will need to demonstrate a ... for Health Care Providers (HCPs) and Patients. Payer medical and pharmacy Utilization Management (UM) criteria create process delays for patients like required… more
- CUNY (Brooklyn, NY)
- …early intervention student support service process, the resolution of student grievances, appeals , and complaints, and the utilization of the Behavioral ... Manager of Student Advocacy and Accountability (HEA) **POSITION...conduct reports; coordinating the student conduct process, grievances, and appeals . + Oversee the Faculty Student Disciplinary Committee to… more
- Ellis Medicine (Schenectady, NY)
- …want to increase your leadership skills and have the support in place to grow? If this appeals to you, then we have a position we would love to speak to you about on ... Surge unit and Float Pool as our next Nurse Manager . WHAT DO YOU GET AT ELLIS MEDICINE? Ellis...nursing care delivery system to assure effective and efficient utilization of staff and other resources for the delivery… more
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