- Molina Healthcare (Albany, NY)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... schedule) Looking for a RN with experience with appeals, claims review , and medical coding....clinical/ medical reviews of retrospective medical claim reviews, medical claims and… more
- Molina Healthcare (Albany, NY)
- …clinical nursing experience. Minimum one year Utilization Review and/or Medical Claims Review . **Required License, Certification, Association** Active, ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...of proactive approaches to improve and standardize overall retrospective claims review . * Ensures core system is… more
- CDPHP (Latham, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... coordinating with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care initial… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- Summary The Albany VAMC is looking to fill (1) Registered Nurse - ACCREDITATION QUALITY SPECIALIST This job announcement is open only for current, full time, ... with driving requirements for this position. Responsibilities The Registered Nurse Accreditation Quality Specialist executes leadership that is characterized by… more
- Northern Rivers Family Services (Troy, NY)
- …an NPI. Claims processing functions also require the NPI of nurse practitioners and physicians. + Federal Drug Enforcement Administration (DEA)number - issued by ... Nurse Practitioner - Psychiatry Job Details Job Location...and education to staff + Prescribe medications, monitor, and review of drug regimen for enrolled individuals + Participate… more
- Humana (Albany, NY)
- …action. + Complete medical record reviews + Assess discharge plans + Review and extract information from claims + Complete documentation for Quality Reviews ... the appropriate courses of action. The Utilization Management Behavioral Health Nurse 2 completes medical record reviews from medical records sent from… more
- Molina Healthcare (Albany, NY)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… more
- CVS Health (Albany, NY)
- …frontline advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management ... in Microsoft Word, Excel, and Outlook - Active and unrestricted Licensed Practical Nurse (LPN) licensure in , Pennsylvania, and/or New Jersey or Compact -… more
- Elevance Health (Latham, NY)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of… more
- Sedgwick (Albany, NY)
- …review process including making a recommendation of specialty for the Independent Medical Review process. + Developing and delivering training materials and ... Best Workplaces in Financial Services & Insurance Sr VP Medical Director (Hourly) The ideal candidate would work 8-20...the following: + Conducting reviews on cases where the nurse is seeking treatment plan clarification, claim … more
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