Performing clinical reviews to resolve and process appeals, the full-time New York Licensed Clinical Reviewer will analyze medical records and clinical data to determine medical necessity for services while working remotely. Key responsibilities Prepares case reviews for Medical Directors by researching appeals and analyzing applicable criteria Ensures timely review and processing of appeals in accordance with State, Federal, and NCQA standards Communicates with members, providers, and facilities regarding appeals requests and generates appropriate resolution communications Required qualifications Active, unrestricted New York State RN license or equivalent licensure (LCSW, LMHC, LPC, LMFT, or Licensed Psychologist) Bachelor's degree in Nursing or a Master's degree in Behavioral Health or Social Work 2+ years of experience in acute care, utilization management, or appeals Knowledge of MCG/InterQual criteria and NYS Medicaid, Medicare, and Marketplace appeal regulations Utilization management certification (CCM) preferred
...liquid chemical transportation, seeks a Class-A CDL Local Company Driver. In this on-site role, youll safely haul liquid chemical loads... ...your local region, emphasizing strict adherence to safety, hazmat, and DOT regulations. Youll perform pre/post-trip inspections,...
...for 1yr+ experience and 50mi The Echo Technologist oversees technical procedures, patient... ...purpose you were meant for. At Carle Health, were committed to fostering a workplace... ...Department of Homeland Security with information from each new employees Form I-9 to confirm...
...Security OfficerThe Global Security (GS) North America Physical Security team consists of a dynamic group of security professionals who are responsible for providing a safe and secure environment for our employees, clients, and assets in our retail and corporate environments...
...means every Employee-Owner shares in the companys success and growth.Let's talk about the Case Manager position!This full-time, hybrid position combines remote work from your home office with travel of up to approximately one hour for community-based meetings several...
...features.Direct message the job poster from Curant HealthJOIN A LEADING HEALTHCARE COMPANYCurant Health is searching for a Financial Analyst (Data) to join its team in Smyrna, GA.At Curant Health, were a mission-driven specialty pharmacy and analytics company dedicated...