- Molina Healthcare (Yonkers, 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
- CP Unlimited (Carmel, NY)
- Registered Nurse Type of Position Full time Search Location(s) Carmel, NY, Fishkill, NY, Garrison, NY, Poughkeepsie, NY, Yonkers, NY Apply Now ... (https://phe.tbe.taleo.net/phe03/ats/careers/v2/applyRequisition?org=CPOFNYS&cws=45&rid=6353) Job Brief The Registered Nurse shall provide health related services to individuals who… more
- Molina Healthcare (Yonkers, 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 (Yonkers, 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
- Nuvance Health (Danbury, CT)
- …Appeals:* * *Root Cause Analysis:* Lead a specialized team to thoroughly investigate claims denied for medical necessity on bedded patients, identify root causes ... conversion rates, medical necessity outreach, and feedback to the utilization review team on denial outcomes. * *Discharge Planning & Social Work:* *… more
- CP Unlimited (Fishkill, NY)
- …Job Brief Provides supervision, training and guidance to the nurse case managers. Shift Worked: Varied Weekly Hours: 37.5 FLSA ... and regulations. Provides technical assistance and resources, as needed, on medical /nursing practices and participates in the development and monitoring of programs… more