- VNS Health (Manhattan, NY)
- …complexities of healthcare? VNS Health Plans is seeking a dedicated Manager, Grievance and Appeals (RN)to lead the daily operations of our grievance and appeals ... * Lead with Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long Term Care (MLTC), Medicare Advantage (MA), or… more
- Mount Sinai Health System (New York, NY)
- …collaboratively with physicians and managed care companies on concurrent denial appeals * Communicates clinical information to the payor, as needed, coordinating ... and monitoring of discharge planning process in collaboration with the clinical nurse initiates the discharge planning process on admission. * In collaboration with… more
- NJM Insurance (Trenton, NJ)
- …(ODG and/or MCG). + Conduct second level review of PIP Post-Service/Payment Appeals to assess prior determination and new records, including treatment, Independent ... business process improvements. Required Skills & Experience: + Actively licensed registered Nurse in New Jersey and Connecticut, Delaware, Maryland, New York or… more
- Mount Sinai Health System (New York, NY)
- …collaboratively with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the payor, as needed, coordinating ... assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission). b. Obtains… more
- Molina Healthcare (New York, NY)
- …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends… more
- Mount Sinai Health System (New York, NY)
- …collaboratively with physicians and managed care companies on concurrent denial appeals 5. Communicates clinical information to the payor, as needed, coordinating ... assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission). 2. Obtains… more
- Mount Sinai Health System (New York, NY)
- …Masters preferred + 5 years case management and 6 years as clinical nurse . Previous supervisory experience in case management or related field. + Name: Current ... to ensure appropriateness of admissions and proper reimbursement. 12.Ensures Discharge Appeals functions are carried out within contractual, federal and state… more
- Mount Sinai Health System (New York, NY)
- …hospital personnel as needed. The Nursing Clinical Manager collaborates with Appeals Management, Managed Care Contracting and other institutional departments to ... management experience and 5 -7 years of experience as a clinical nurse . Licensing and Certification Requirements (if applicable) License: RN (current) and… more
- Hackensack Meridian Health (Edison, NJ)
- …care management processes, including LOS, throughput, patient flow and denials and appeals follow up. + Applies process improvement methodologies in evaluating team ... Suite platforms. **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License or NJ Licensed Social Worker or NJ Licensed Clinical… more
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …+ Work with insurance carriers and MSKCC billing departments to initiate appeals and acquire authorizations for treatment Key Qualifications: + Current NYS ... Registered Nurse License/Registration and BSN preferred + At least 2-3 years of clinical hospital nursing experience + Managed care/UR/CM experience strongly… more
- VNS Health (Manhattan, NY)
- …of all BH QM/UM and performance improvement activities, encompassing grievances and appeals , and contributes to various other subcommittees such as Compliance and ... State or other independent licensure (LMHC, LMFT, clinical psychologist, or psychiatric Nurse Practitioner). required + Licensure in other states is an additional… more
- VNS Health (Manhattan, NY)
- …with other departments, eg Care Management, Legal Affairs, Grievance and Appeals , Compliance, Membership Eligibility Unit, Quality as needed. + Participates in ... and Certifications: + Current license to practice as a Registered Professional Nurse in New York State required + Certified Case Manager preferred Education:… more
- Mount Sinai Health System (New York, NY)
- …for the services provided. + Current experience with prior authorizations, claims, appeals , discharge planning. + Licensed as a registered professional nurse ... with current registration in New York State. + Basic Life Saver (BCLS) Required Issuing Agency: AHA **Responsibilities** + Develops, implements, and maintains professional and hospital standards to support outcomes-based care and evidence-based nursing… more
- Hackensack Meridian Health (Holmdel, NJ)
- …information to insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews. + Obtains and ... management. **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License. + AHA Basic Health Care Life Support HCP Certification.… more
- Hackensack Meridian Health (Holmdel, NJ)
- …information to insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews. + Obtains and ... management **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License. + AHA Basic Health Care Life Support HCP Certification.… more