- BronxCare Health System (Bronx, NY)
- …Management Position Type Regular Full-Time Division Bronxcare- Yonkers Max USD $97,125.00/Yr. Shift Day Shift Department : Name Appeals Department (BHCS) ... the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to… more
- VNS Health (Manhattan, NY)
- …the day to day management of clinical appeals review processes within Appeals & Grievances Department . + Manages the intake, investigation and resolution of ... of members experience with A&G. + Tracks grievances and appeals that are in process in the department...Relations, Claims, Medical Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and… more
- The Mount Sinai Health System (New York, NY)
- **JOB DESCRIPTION** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Hackensack Meridian Health (Hackensack, NJ)
- …determinations - OBS vs. Inpatient c. Liaison to the Medical Staff supporting Utilization Management Committee processes d. Hospital Based Appeals Management e. ... documentation iv. Target DRGs Reviews v. Use of case manager as a resource 4. Uses guidelines to evaluate...e. Provides professional support to the functions within the Utilization Management Department f. Provides periodic written… more
- The Mount Sinai Health System (New York, NY)
- …to insure patient admission is approved Identifies and refers to the UM Manager &/or Administrator and/or Physician problematic utilization and quality issues ... Responsible for the maintenance of accurate data for approvals, denials and appeals (in coordination with UM Manager and management). Prioritizes insurance… more
- Hackensack Meridian Health (Hackensack, NJ)
- …information to insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews. + Obtains ... and serve as a leader of positive change. The Case Management Care Coordinator, Utilization Management is a member of the healthcare team and is responsible for… more
- The Mount Sinai Health System (New York, NY)
- …homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager or a minimum of 3-5 years experience as a ... **JOB DESCRIPTION** **RN/Case Manager MSH Case Management FT Days** The Case...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- The Mount Sinai Health System (New York, NY)
- …homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager or a minimum of 3-5 years experience as a ... **JOB DESCRIPTION** The Case Manager (CM) will be responsible for all aspects...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- The Mount Sinai Health System (New York, NY)
- **JOB DESCRIPTION** The Case Manager is responsible for all aspects of case management/ utilization review for an assigned group of inpatients, ED patients and ... basis and identify the expected length of stay (ELOS). The case manager works collaboratively with physicians, social workers, clinical nurses, home care services,… more
- The Mount Sinai Health System (New York, NY)
- …to Case Managers and other hospital personnel as needed. The Nursing Clinical Manager collaborates with Appeals Management, Managed Care Contracting, and other ... **JOB DESCRIPTION** **The Nursing Clinical Manager (NCM) for Case Management - Mount Sinai...patient care. + Demonstrates integral involvement in the Nursing Department PI/QA program. + Participates in monthly Nursing … more
- Hackensack Meridian Health (Hackensack, NJ)
- …information to insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews + Obtains ... and serve as a leader of positive change. The **Case Management Care Coordinator, Utilization Management** is a member of the healthcare team and is responsible for… more
- VNS Health (Manhattan, NY)
- …+ Engages in and contributes to the interdisciplinary team's utilization management activities and recommended interventions for members/participants. Establish ... and implementation of the behavioral health sections of the Quality Management (QM)/ Utilization Management (UM) Plan. Oversees the administration of all BH QM/UM and… more
- WMCHealth (Valhalla, NY)
- …NorthEast Provider Solutions Inc. City/State: Valhalla, NY Category: Professional/Non-Clinical Department : Health Info Mgmt-WMC Health Union: No Position: Full Time ... Details: Job Summary: The Senior Inpatient Coder is responsible for addressing appeals to insurance companies and coding highly complex medical records, including… more
- Hackensack Meridian Health (Hackensack, NJ)
- …ortho calls, payer communications and support of the Care Coordinators. Prepares required Appeals and Denial information for processing and follows up on receipt of ... Oversees the sorting and distribution of mail in the department . Answers case management and social work phones. Medicaid...of free text fields, to support the case management, utilization review process. + Retrieves information for the Physician… more