• Clinical Appeals Nurse…

    Molina Healthcare (Yonkers, NY)
    … decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making...these guidelines. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
    Molina Healthcare (08/15/25)
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  • Medical Claim Review Nurse ( RN )

    Molina Healthcare (Yonkers, NY)
    …hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing ... resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical … more
    Molina Healthcare (09/06/25)
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  • RN /Case Manager-MSH-Case…

    Mount Sinai Health System (New York, NY)
    …for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission). ... **Job Description** ** RN /Case Manager MSH Case Management FT Days** The...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the… more
    Mount Sinai Health System (08/28/25)
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  • RN /Case Manager-Inpatient-Mount Sinai…

    Mount Sinai Health System (New York, NY)
    …for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission). ... **Job Description** RN /Case Manager Mount Sinai West FT Days 8a-4p...with physicians and managed care companies on concurrent denial appeals 5. Communicates clinical information to the… more
    Mount Sinai Health System (08/16/25)
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  • RN Case Manager, Inpatient

    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
    Memorial Sloan-Kettering Cancer Center (09/11/25)
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  • Director of Care Management - Mount Sinai Queens…

    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
    Mount Sinai Health System (07/24/25)
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  • Administrator of Admissions, Outreach & Intake

    Calvary Hospital (Bronx, NY)
    …year Requirements QUALIFICATIONS: 1. Master of Nursing Degree required. 2. NYS unencumbered Registered Nurse License required. 3. Ten (10) to fifteen (15) years ... to facilitate reimbursement for services provided by the Hospital. Oversees the appeals process for those cases for which reimbursement has been denied. Conducts… more
    Calvary Hospital (08/20/25)
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