- HCR Home Care (Rochester, NY)
- Role and Responsibilities The Utilization Review Specialist is responsible for performing utilization review activities including technical audit of ... corrective action as needed. + Provide staff training for new Utilization Review initiatives and monitors the performance of assigned branches. + Participate… more
- Northwell Health (Melville, NY)
- …level of care decisions and billing status and ensures compliance with the Utilization Review standard and regulations. Performs concurrent and retrospective ... entry date. + Current License to practice as a Registered Professional Nurse in New York State...certifications as needed. + Prior experience in Case Management, Utilization Review , and Appeals/Denials, highly preferred. *Additional… more
- Guthrie (Binghamton, NY)
- …in an acute care setting along with current CCDS certification may substitute for BSN RN ‐PA Registered Nurse ‐ PA: Current Pennsylvania State registered ... acute clinical experience in a hospital setting required. Critical care, utilization review or coding experience required. Requires excellent communication… more
- Healthfirst (NY)
- …in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management/case management. + Demonstrated ... of services. The end to end process requires the Specialist to independently: + Research issues + Quality of...understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual,… more
- Nuvance Health (Poughkeepsie, NY)
- …sound judgment based on factual information and clinical knowledge. Education Skills Experience: 1. Registered Nurse ( RN ) with 5 years recent experience in ... and accurate and reflects severity of illness and resource utilization . Participates in the education of all members of...preferred. 2. BS or above preferred. 3. Current NY/CT RN Licensure required. 1. Registered Nurse… more
- WMCHealth (Valhalla, NY)
- …Registered Health Information Technician/Administrator . RN : Current/active license as a registered nurse in the state of residence or current /active ... Clin. Documentation Specialist Company: NorthEast Provider Solutions Inc. City/State: Valhalla,...principles and guidelines; good knowledge of healthcare delivery system, utilization review , case review and… more
- Albany Medical Center (Albany, NY)
- …field of Clinical Social Work or Nursing with experience in Case Management, Utilization Review and Discharge Planning. * BLS Certification. * Demonstrated ... will be prorated based on hours worked. The Education Specialist is expected to utilize their knowledge and skills...to accomplish the goals of the organization. The Education Specialist achieves this goal through the roles of educator,… more
- Catholic Health Services (Melville, NY)
- …Island's Top Workplace! Job Details The Professional Fee (ProFee) Clinical Documentation Specialist (CDS) will serve as an advisor and expert resource for providers ... The ProFee CDS will focus on pre-visit provider support, post-visit provider review , and collaboration and education with providers. Pre-visit provider support -… more
- VNS Health (Manhattan, NY)
- …to State Fair Hearings. Attends Fair Hearings in person with the Grievance and Appeals' RN Specialist and presents arguments in defense of the appeals. + Works ... of the plan's fiduciary responsibilities. Prepares records for physician review as needed. + Conducts review of...and appeals or related area such as medical or utilization management in a Managed Care setting required +… more
- Highmark Health (Albany, NY)
- …Counselor (LPC) + Licensed Marriage and Family Therapist (LMFT) + Licensed Behavior Specialist + Registered Nurse . **Preferred** + None **SKILLS** + ... Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health care… more
- The Institute for Family Health (New York, NY)
- …Must have at least one of the listed licensures/certifications: Current NY State Registered Nurse ( RN ) or Certified Dietitian/Nutritionist (CDN) or Current ... Health Care Description SUMMARY: The Certified Diabetes Care and Education Specialist , in collaboration with the multidisciplinary team and in accordance with… more
- STG International (Watertown, NY)
- …in the management/coordination of the clinic's day-to-day activity, in conjunction with the Registered Nurse ( RN )/CBOC Manager and VA Program's philosophy. + ... Participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes,...Corps - 60J, 60L, 61F, 61H, 61N, 61R,62B Medical Specialist Corps - 65B, 65C, 65D Nurse … more
- WMCHealth (Valhalla, NY)
- …experience in a hospital setting, preferably cardiology, radiology, surgery or utilization review , required. Previous revenue integrity experience, Excel and ... pre-bill and post-bill claim edits involving any type of clinical or coding review or required modifier based on services rendered. + Analyze and maintain WMCHealth… more