- Molina Healthcare (Yonkers, 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
- New York State Civil Service (New York, NY)
- NY HELP No Agency Attorney General, Office of the Title Legal Nurse | Review Medical Malpractice Claims for NYS (6402) Occupational Category Legal Salary ... to the Claims Bureau will analyze and review claims containing allegations of medical...and be registered to practice as a registered professional nurse or licensed physician in New York state. It… more
- Molina Healthcare (Yonkers, 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
- Centene Corporation (New York, NY)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review ... and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review and… more
- Constructive Partnerships Unlimited (Manhattan, NY)
- …Interdisciplinary Treatment Team to ensure that all team members are aware of all medical conditions and care. 8. Review reports daily to ensure timely, ... in all corporate compliance investigations and reviews. SUPERVISES: Nurse Educators Nurse Case Managers (NCM) Medical Case Manager Counselors (MCMC) more
- Travelers Insurance Company (New York, NY)
- …Utilize evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... evaluating, reserving, negotiating and resolving assigned serious and complex Specialty claims . Provides quality claim handling throughout the claim… more
- Centene Corporation (Queens, NY)
- …terminology such as ICD 10 codes, medical abbreviations, medications. Experience in medical records review , claims processing or utilization and case ... Quality Assurance RN will work in various capacities to review , monitor and train staff in the Long Term...order to ensure that all components of the Member's medical record are completed with quality standards and accuracy… more
- Molina Healthcare (Yonkers, 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
- BronxCare Health System (Bronx, NY)
- …(according to the NPSG), intake screening of patient, pre-visit planning (if applicable), review of medical record to determine visit requirements such as HEIDS ... Overview Licensed Practical Nurse : Under the direct supervision of a physician...analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality… more
- Elevance Health (Morristown, NJ)
- **Telephonic RN Nurse Case Manager I** **Sign On Bonus: $3000** **Location: This role enables associates to work virtually full-time, with the exception of required ... in different states; therefore Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager I** is responsible for performing care management within… more
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