Utilization Review Clinician, Advocate, Virtual

Job Title: Healthcare - Care Review Clinician I Location: Remote (Must possess NY Nursing License) Duration: 6 Months Job Description: Work Location (i.e., onsite or remotely based): Remote-based but candidates can be located anywhere in the US but must be licensed in NY StateWill now accept RNs! Reason for Job Request: 1 CRC left last year and last...

Job DescriptionJob DescriptionVivo HealthStaff is recruiting for a Utilization Review Physician based in New York for a Managed Care Insurance Plan. This position requires 4 days per month on-site.The Utilization Review Physician is the lead clinician for the health plan. Responsible for the administration of medical services for company health plan...

Utilization Review Case Manager The UR Case Manager will complete prior authorizations and concurrent reviews for new admissions or existing patients. The UR Case Manger will work with insurance companies and the clinical team, reviewing documentation to determine medical necessity criteria and length of stay. Responsibilities Obtain prior authorizations for...

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Must have a New York State clinical license. Position Purpose: Performs...

Job DescriptionJob DescriptionUtilization Review Case ManagerThe UR Case Manager will complete prior authorizations and concurrent reviews for new admissions or existing patients. The UR Case Manger will work with insurance companies and the clinical team, reviewing documentation to determine medical necessity criteria and length of...

Elmhurst Hospital Center (EHC) is the major tertiary care provider in the borough of Queens. The hospital is comprised of 545 beds and is a Level I Trauma Center, an Emergency Heart Care Station and a 911 Receiving Hospital. It is the premiere health care organization for key areas such as Surgery, Cardiology, Women's Health, Pediatrics, Rehabilitation...

Introduction Make a Difference with DHSS Our mission at the Department of Health and Social Services (DHSS) is to improve the quality of life of Delaware citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations. We prioritize personal and family independence by assisting individuals and families...

A growing health services network in New York is currently seeking an experienced, licensed Registered Nurse (RN) to join their Case Management team as a Utilization Review Manager. In this role, the Utilization Review Manager (RN) will be responsible for assisting the Director of Case Management in overseeing the Utilization Management Program.About the...

Job DescriptionJob DescriptionYoung Invincibles is building a movement! We are looking for young adults ready and excited to become the next generation of community leaders. This program is a unique hands-on leadership development program aimed to train young people to engage in their community around major issues that impact our generations. The Young...

Woodhull Medical and Mental Health Center is attuned to the healthcare issues that matter to the people of North Brooklyn. Woodhull focuses on preventing disease and promoting healthy lifestyles by reaching out to the community at various locations.At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception....

About Alaffia & Our MissionEach year, the U.S. healthcare system suffers from over $500B in wasted spending due to medical billing fraud, waste, and administrative burden. At Alaffia, we're on a mission to change that. We've assembled a team of clinicians, AI/ML engineers, and product experts to build advanced AI that finally bends the cost curve for all...

Job DescriptionJob DescriptionPosition: Telebehavioral Health ClinicianLocation: (Remote)Type: Part-time / Full-timeCompany Overview:At Ladgov, we are committed to providing accessible and high-quality healthcare services to diverse populations across the country. Our Telebehavioral Health program, based on cutting-edge televideo technology, connects...

About Alaffia & Our Mission Each year, the U.S. healthcare system suffers from over $500B in wasted spending due to medical billing fraud, waste, and administrative burden. At Alaffia, we're on a mission to change that. We've assembled a team of clinicians, AI/ML engineers, and product experts to build advanced AI that finally bends the cost curve for all...

Clinician/Therapist (LCSW, LMSW, MHC-LP)Cobb Psychotherapy LCSW is a private group psychotherapy practice offering therapy to individuals, couples, children, and families. We give our therapists the autonomy to approach their clients with a tailored and individualized approach that best fits their needs. Our offices are conveniently located in Brooklyn...

Overview: To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day. The Utilization Review Specialist (URS) performs...

Overview To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day. The QA Home Care Reviewer will facilitate the process of...

Position Summary At MedReview, our mission is to bring accuracy, accountability and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. Pricing and analysis of inpatient medical claims utilizing NYCHSRO/MedReview and payer specific systems,...

The following duties are normal for this position. These are not to be construed as exclusive or all-inclusive. Other duties may be required and assigned. Leads, supervises and directs the workload in the department and with associated stakeholders review and access payer reports as they pertain to the utilization of days, level of care, services and...

43 New Scotland Avenue Albany, NY 12208Department/Unit:Care Management/Social WorkWork Shift:Day (United States of America)Utilization Review NurseSalary Range: $31.28 - $51.61 per hourResponsible for Utilization Management, Quality Screening and Delay Management forassigned patients.Qualifications and Ideal Characteristics Registered nurse with a New York...

Overview: The Virtual Auditor performs virtual audits of varying complexity ensuring the accuracy of earned premium risk calculations. Responsible for handling of audits within the $10,000 to $50,000 estimated premium range. Investigates and verifies the premium base exposures according to policy contract terms, manual rules, company filings, and procedures....