Search Results: 39,255 vacancies
...who changes everything for our 28 million members as a clinical professional on our Medical Management/Health... ...license.**
**Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine...
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Holiday work
Remote job
Flexible hours
As a Clinical Reviewer you will complete the full spectrum of activities related to State Independent Review Organization (IRO) case determinations... ...case staging between external physician experts and manage appeal processes within strict deadlines. Duties include but are not...
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Flexible hours
...JOB PURPOSE:
Under the direction of the Senior Director of Clinical Review, the Clinical Review Nurse is responsible for complying with the day-to-day operations of the Clinical Review Department. Responsibilities include reviewing, recommending and providing authorization...
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Flexible hours
...include:
Sign-on Bonuses OR Student Loan Assistance for clinical staff
FREE Online RN to BSN and MSN degree programs!... ...for direct oversight and management of clinical review processes within Appeals & Grievances Department. Ensures regulatory compliance and...
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Holiday work
Full time
Part time
Relocation bonus
Flexible hours
...Job Title: Grievance and Appeals Registered Nurse
Location: New York, New York 10017, United... ...looking for a skilled Registered Nurse to join our Clinical Appeals team, which handles grievances, appeals, and external reviews for our health plans product lines - Managed...
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Full time
Work experience placement
Monday to Friday
...volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience.
The Appeals Coordinator is responsible for the timely and accurate triaging all appeals, grievances, and complaints that come in to the department...
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Work experience placement
Flexible hours
...admissions and continued stays, and documents findings based on Departmental standards.
• While performing utilization review identifies areas for clinical documentation improvement and contacts appropriate department.
• Identifies at-risk populations using approved...
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Permanent employment
Shift work
...Work
Work Shift:
Day (United States of America)
Utilization Review Nurse
Salary Range: $31.28 - $51.61 per hour
Responsible... ...degree required. Masters degree preferred.
Minimum of three years clinical experience in an assigned service.
Recent experience in case...
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Hourly pay
Permanent employment
Shift work
...Grievance and Appeals Coordinator
75 Vanderbilt Ave, Staten Island, NY 10304, USA
Req #660
Friday, May 3, 2024
Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision...
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Hourly pay
Professional, Concurrent Review - RN
625 State St, Schenectady, NY 12305, USA • Rochester, NY, USA • Tarrytown, NY, USA • Vermont,... ...level of care assignment.
Reviews individual claims requiring clinical interpretation and judgment.
Tracks on a regular basis the required...
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Permanent employment
Full time
Contract work
Local area
Remote job
Afternoon shift
...of department processes and systems. Able to act as an operations' liaison, collaborating with various entities including payers, clinical, financial and/or operational departments. Duties/Responsibilities: Conducts data analysis with a high degree of complexity and prepares...
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...be part of our transformation across the enterprise.
DRG Reviewer
Full-Time
The DRG Reviewer reports to the Director of... ...conflicting, or incomplete documentation.
Works closely with Clinical Documentation Improvement (CDI) to identify areas of documentation...
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Full time
Work experience placement
...HEDIS Reviewer
990 Stewart Ave, Garden City, NY 11530, USA
Req #879
Monday, April 29, 2024
Centers Plan for Healthy Living'... ...are not limited to coordination of outreach efforts to secure clinical documentation from Providers, reviewing and abstracting data from...
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...POSITION SUMMARY
The Utilization Review Care Manager performs initial, concurrent, and retrospective... ...stay reviews, and retrospective reviews; provides clinical information after patient discharges.
Coordinates appeal process with concurrent denials from third party...
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Hourly pay
Shift work
...medication records. Abstracts pertinent clinical information from these records to determine... ...assigns appropriate level of care. The Reviewer is responsible for obtaining the order... ...up by sending an email to Supervisor and Appeal team.
11. Notifies the managed care...
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Holiday work
Immediate start
Shift work
...NYC Department of Design and Construction, Public Buildings Division, Architecture & Engineering Unit seeks an Electrical Design Reviewer.
The duties for this position will include, but are not limited to, project scoping, design and/or review of consultant drawings...
Permanent employment
Full time
For contractors
...Living Program, Care at Home Program and Homebound Medicaid. The Medicaid Eligibility Unit is responsible for the Medicaid eligibility review and processing of initial applications, change actions, and renewals for all Medicaid funded long term care programs. This unit is...
Full time
Contract work
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Care Review Clinician
Remote: New York, New York, US
Salary: $45.00 Per... ...cases to Medical Director make appropriate referrals to other clinical programs, collaborate with multidisciplinary teams.
Minimum...
Hourly pay
Remote job
...independent initiative and judgment, the Medicaid Eligibility Specialist is responsible for interviewing Medicaid applicants and reviewing their documentation to determine eligibility for Medicaid.
The Office of Constituent Services (OCS) is seeking (1) Eligibility...
Full time
Work experience placement
Shift work
...An employee in this class is responsible for the review and evaluation of real property appraisals made by appraisers contracted by the County. The incumbent assists in the collection of data to establish fair market values of parcels of property, and exercises considerable...
Permanent employment
Temporary work
Relocation package
