- Molina Healthcare (Rochester, NY)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...Claims Auditing, Medical Necessity Review and Coding experience +… more
- Molina Healthcare (Rochester, NY)
- … claims with corresponding medical records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines, and provider ... policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or… more
- Molina Healthcare (Rochester, NY)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
- Independent Health (Buffalo, NY)
- …UM pre-service, concurrent and retrospective review , services not currently on medical review as outlined by trend and cost containment activities, and ... of clinical care management processes, member benefit structures and applications, and claims processing. + Knowledge of medical necessity criteria development, … more
- Independent Health (Buffalo, NY)
- …database. + Provide high quality, professional utilization management services: ( medical necessity review for Prior Authorization, pre-certification, and ... with designated turnaround time. + Clear documentation of clinical information for medical necessity review of all requests, procedures, admissions, and… more
- Veterans Affairs, Veterans Health Administration (Batavia, NY)
- …for delivery of primary care to patients enrolled at the WNY VA Medical Center at the Community Living Centers. The geriatrician will work in collaboration ... with other geriatricians, geriatric nurse practitioners, and other nursing staff. The geriatrician is...line. The geriatrician may be expected to cover as Medical Director of the Community Living Centers, which will… more
- Veterans Affairs, Veterans Health Administration (Buffalo, NY)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... coverage and urgent clinical services. Additional duties may include supervision of medical students and residents in both the out-patient clinic and during surgical… more