• Medical Claim Review

    Molina Healthcare (New York, NY)
    …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... more
    Molina Healthcare (01/25/25)
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  • Auto FPM Litigation Arbitration Claim

    Travelers Insurance Company (Melville, NY)
    …law in conjunction with Claim counsel and First Party Medical claim professional, if necessary. Proactively manage ongoing litigation/arbitration through ... more
    Travelers Insurance Company (02/05/25)
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  • Major Case Specialist, Liability (Construction)

    Travelers Insurance Company (Melville, NY)
    …Utilize evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... more
    Travelers Insurance Company (12/20/24)
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  • Clinical Appeals Nurse (RN): Texas and New…

    Molina Healthcare (New York, NY)
    …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... more
    Molina Healthcare (02/09/25)
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  • Licensed Practical Nurse 1199 Line

    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 ... more
    BronxCare Health System (12/18/24)
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  • Utilization Review Manager-Selikoff Centers…

    Mount Sinai Health System (New York, NY)
    …practices; routes requests to medical leadership when appropriate + Documents authorization review for medical and pharmacy claims . + Prepares case ... more
    Mount Sinai Health System (01/30/25)
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  • Medical Data Entry Manager

    Constructive Partnerships Unlimited (Manhattan, NY)
    …in the management of medications. POSITION DUTIES1. Maintain effective communication on medical issues with VP of Nursing, Nurse Administrator, Registered ... more
    Constructive Partnerships Unlimited (02/05/25)
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  • Medical Director

    Brighton Health Plan Solutions, LLC (Westbury, NY)
    …and guidelines. + Provides clinical support for all areas of Clinical Services. + Review medical files and make coverage and medical necessity determinations ... more
    Brighton Health Plan Solutions, LLC (12/12/24)
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  • Medical Director (Medicare)

    Molina Healthcare (New York, NY)
    …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... more
    Molina Healthcare (02/09/25)
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  • Medical Director Specialty Medical

    Molina Healthcare (New York, NY)
    …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... more
    Molina Healthcare (02/07/25)
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  • Medical Assistant- 1199 | Line

    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 ... more
    BronxCare Health System (12/18/24)
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  • Medicolegal Analyst (Law Dept) Lv2

    City of New York (New York, NY)
    …compensability of treatment as it relates to the claimant's work injury and assist with medical case management of claims . Review and process high value and ... more
    City of New York (02/12/25)
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  • Clinical Risk Manager

    Mount Sinai Health System (New York, NY)
    …for reviewing, summarizing, analyzing, presenting and monitoring safety events, claims management, loss prevention and reduction, patient safety related quality ... more
    Mount Sinai Health System (12/31/24)
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  • Manager, Grievance and Appeals, RN

    VNS Health (Manhattan, NY)
    …incidents, quality of care concerns and any other inquires requiring clinical review for medical necessity, appropriateness of service or clinical quality. ... more
    VNS Health (12/04/24)
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  • Grievance & Appeals Specialist, Clinical

    VNS Health (Manhattan, NY)
    …Improvement Organizations. + Collaborates with professionals, health plan departments such as Claims and Medical Management, and the third party administrator ... more
    VNS Health (02/07/25)
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  • Intake Coordinator

    Brighton Health Plan Solutions, LLC (New York, NY)
    …+ Inform callers that the Nurse Case Reviewer may obtain additional medical information for review and certification. + (In regard to discharge planning ... more
    Brighton Health Plan Solutions, LLC (01/22/25)
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  • Case Manager NYSNA Line

    BronxCare Health System (Bronx, NY)
    …collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement ... more
    BronxCare Health System (12/18/24)
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  • Appeals Manager, Department of Utilization Case…

    BronxCare Health System (Bronx, NY)
    …projects and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate with ... more
    BronxCare Health System (12/18/24)
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