- Brighton Health Plan Solutions, LLC (New York, NY)
- …Workers' Compensation and other Casualty clients. The Workers' Compensation Nurse Case Reviewer collaborates with medical care providers, employers, employees, ... The Role Brighton Health Plan Solutions (BHPS) provides Utilization Review /Medical and Case Management services for Group...the evaluation of coverage under the Plan. The Nurse Case Reviewer reports to the Casualty Department… more
- City of New York (New York, NY)
- …The Office of Constituent Services (OCS) is seeking (1) Eligibility Specialist II to function as Case Reviewer . The Case Reviewer will: - Respond to ... (NAMI-Net Available Monthly Income) if institutionalized. - Interview and/or review documentation submitted by applicants/recipients (A/R) or authorized representatives,… more
- City of New York (New York, NY)
- …for (1) one Principal Administrative Associate II to function as a Quality Control Case Reviewer , who will: - Conduct the preliminary monthly review ... the review sample by conducting preliminary WMS inquiries and case review ; utilize reports to verify that sample is auditable; identifies inconsistencies,… more
- City of New York (New York, NY)
- …the final report. CA PERT Sr. Reviewer prepares lawsuit packets for each case in the review for electronic transmission to NYC Corporation Counsel. - Conduct ... during customer interaction, and determine whether appropriate action was taken. - Review case file information, POS entries and WMS data to report on the… more
- City of New York (New York, NY)
- …Office of Constituent Services (OCS) is seeking (2) Eligibility Specialist II's to function as Case Reviewers. The Case Reviewer will: - Respond to inbound ... (NAMI-Net Available Monthly Income) if institutionalized. - Interview and/or review documentation submitted by applicants/recipients (A/R) or authorized representatives,… more
- City of New York (New York, NY)
- …is recruiting for (1) one Supervisor of Nurses to function as a Complex Medical Case Reviewer , who will: - Conduct medical reviews and analyses claims to ... calculate injury related Medicaid liens pursuant to SSL-104b on cases involving Medical malpractice, mass medical torts, lead paint poisoning, traumatic brain injury, or other catastrophic or medically complex cases. - Consult Medicaid payment records, bills… more
- Trinity Health (Athens, GA)
- …**Position Summary:** To assist with the coordination of the ongoing processes for identifying opportunities to improve the quality of care and services at St. Mary's ... Health Care System. To assist with the coordination of Medical Staff Performance Improvement activities. To compile data and assist with maintaining Physician profiles. **II. Position Requirements** : **A: Licensure/Certification/Registration** : Current… more
- AmeriHealth Caritas (Philadelphia, PA)
- **Clinical Care Reviewer , Pediatric Shift Care, Registered Nurse** Location: Philadelphia, PA Primary Job Function: Medical Management ID**: 34518 Your career starts ... the direction of the unit Supervisor, the Clinical Care Reviewer - Shift Care is responsible for managing requests for...interventions and goals. Following the shift care workflow the case is presented to the Medical Director for medical… more
- City of New York (New York, NY)
- …legal and federal, state and city regulatory requirements. The Process Evaluation Review Team (PERT) is tasked with aggressively monitoring program compliance with ... Assurance & Fiscal Integrity (OQA&FI) / The Process Evaluation Review Team (PERT) is recruiting for (2) one Principal...one Principal Administrative Associates III, to function as Senior Case Reviewers who will: - Conduct legally mandated … more
- City of New York (New York, NY)
- …for (2) two Principal Administrative Associates II to function as a Quality Control Case Reviewers, who will: - Review POS, HRA One Viewer of imaged/scanned ... to ensure that data collected is complete, accurate and appropriate to the case under review . - Prepare manual budgets to replicate the actual amounts issued to… more