Appeals nurse jobs in Jersey City, New JerseyCrear alertas

Job DescriptionDescription: BASIC FUNCTION: Operates the program effectively, efficiently, and in compliance with the policies and procedures of LESC, OASAS, CARF, and other appropriate regulatory agencies. Provides clinical supervision to identified staff under the Divisional Director's supervision. MAJOR DUTIES: · Facilitates weekly interdisciplinary case conferences and Dose and Schedule meetings, and leads the team to provide person-centered care to clients, including medication and schedule adjustments. client · Coordinates the appeals administrative process and ensures clients' rights to the grievance process are appropriately maintained and documented. Carefully implement program policy to protect clients' rights. · Works with staff and clients, as indicated, to ensure that clients adhere to program policies & procedures; monitors and intervenes in areas of non-adherence to policies and procedures. · Tracks and analyzes treatment data, services, and outcomes, including individual in-person and telehealth, group, vocational, psychiatric, medical, and other LESC services such as Early Intervention Services, Dual Recovery Services, and Residential, as well as linkages with other community providers. · Approves, monitors, and coordinates work schedules, vacations, and days off in ORS I. · Conducts weekly clinical and administrative supervision of counselors. Reviews client charts and provides feedback to supervisorees on record maintenance in compliance with OASAS and regulatory guidelines. Assists counselors with crisis interventions. Liaisons with the Auditors during audits. Conducts on-the-job orientation for new employees. · Participates in the interview and selection process of applicants; evaluates supervisees' performance; creates and distributes work schedule, including vacation back-up coverage; participates with the Divisional Director in decisions concerning disciplinary actions relative to supervisees' employment; approves timesheets and vacation for supervisees. · Assigns clients to counselors based on needs (language, gender, culture, psychiatric history, etc.). · Facilitates weekly client groups and in-service staff training. · Meets with Finance staff to maintain and monitor the fee policy of LESC. · Meets with clients in payment arrears to assist with interventions to rectify arrears and issues a final warning regarding non-payment when indicated. Completes the dose and schedule form in collaboration with the nurse supervisor or designee. · Manages ORS I petty cash. · Meets with vocational staff and collects statistics (training and employment). Compares and verifies statistics of counselors and vocational counselors and completes the OASAS vocational statistical form. · Fills in for other staff who may be on leave. · Performs other tasks as assigned from time to time. SCHEDULE: Full Time SALARY: $65,000 - $70,000 / year dependent on experience LOCATION: NY, NY 10002 We offer excellent benefits including: • Generous time off that includes 4 weeks of vacation, • Medical, Dental, and Vision Insurance, • Discounted Commuter benefits, • Life insurance & Long term disability, • Eligible for Federal Student Loan Repayment Program · Clinical and leadership skills, LMSW or LMHC, plus 2 years of experience, and a CASAC (Certified Alcoholism & Substance Abuse Counselor) Advanced. Must be culturally sensitive to clients' needs in treatment. Computer competent. Compensation details: 65000-70000 Yearly Salary PI2a769b32aa36-25405-39322166

A Manhattan-based healthcare organization is actively seeking an experienced and compassionate professional to join its staff as its new VP of Medical Directors. In this role, the VP will be responsible for assisting in ensuring appropriate health care utilization management (UM). Responsibilities: • Reviews cases, determines medical necessity, and consults with physicians to review length of stay and reimbursement documentation, • Supports the Utilization Management (UM) department staff and nurse Care Managers on concurrent review and preauthorization referrals and ensures that members receive appropriate services consistent with their benefits, regulatory requirements, and established clinical criteria, • Works with the VP of Clinical Services, who oversees day-to-day UM operations. Provides clinical support for member and provider appeals., • Builds a health informatics function and ensures decisions are made according to data insights. Assists in new technology assessment and clinical policy review as required. • Doctor of Medicine or Doctor of Osteopathic Medicine degree from an accredited and approved school of medicine, • Valid and current license to practice medicine in the state of New York, • Board Eligible / Certification

Job Description Overview Physician Affiliate Group of New York (PAGNY) is adding a Unit Chief to the Inpatient Psychiatry department at NYC Health + Hospitals/Jacobi. Jacobi, located in the Bronx, accommodates more than 325,000 outpatient visits, more than 100,000 emergency room visits and more than 20,000 inpatient admissions annually. The hospital is renowned for The Trauma Center, staffed to treat any traumatic injury or illness, the fully accredited Breast Health Center, and The Burn Center, with more than 40 years of work in burn care. The hospital maintains a strong academic affiliation with Albert Einstein Medical College. The Department of Psychiatry has 89 adult acute inpatient beds, a CPEP, a Consultation-Liaison Service, an Adult Ambulatory Practice, and a Community-Based Assertive Community Treatment Program. The department employs evidenced-based best practices in providing the highest quality care to its patients, in a patient-centered approach that is respectful of their individuality, culture, and community. The mission of NYCHHC is to extend equally to all New Yorkers, regardless of the ability to pay, comprehensive health services of the highest quality in an atmosphere of humane care, dignity, and respect. Their Values are built on a foundation of social and racial equity and has established the ICARE standards for all staff. Responsibilities The Unit Chief collaborates with a robust interdisciplinary treatment team, including nurses, psychologists, clinical pharmacists, social workers, licensed creative arts therapists, and peer counselors to oversee daily operations of an Adult Inpatient Behavioral Health Unit. Oversee Unit Clinical Structure • Establish and oversee interdisciplinary teams and team meetings, • Ensure that community meetings and other therapeutic groups take place as scheduled, • Participate in Behavioral Codes on the unit, providing leadership to the staff and patient community, • Work with all teams on the unit to monitor length of stay and appropriate dispositions, particularly ensuring that:, • Patients who are refusing medications are taken to court promptly, • Patients who have reached their 18th day are referred for state hospitalization for continuing treatment, • Patients who would benefit from AOT are referred promptly, • Other potential barriers to discharge are identified and solved for, • Work with the medical-consultation team ensure that medical problems are properly identified and managed, • Ensure that legal statuses are up to date and accurate, • Provide clinical consultation to teams on your unit, • Assist and supervise unit psychiatrists and nurse practitioners as needed, • Monitor the need for psychiatrist assessments and other components of applications of aftercare, in such applications for appropriate housing, residential placements and state referrals, • Participate in Performance Improvement and Quality Assurance activities, including chart reviews. Educates unit staff members on Performance Improvement, Quality Assurance activities, indicators, etc. and be able to help the unit improve if their performance is below the mean for the service, • In collaboration with risk management reviews major incidents on the inpatient unit, • Assist in the preparation for surveys, • Work with the UM department to conduct MD to MD reviews and participate in any appeals to ensure authorization of inpatient stays, • Maintains focus on key strategic priorities including patient experience, access to care, increased market share, and improving financial stability Qualifications • Must be board-eligible or board-certified in Psychiatry, • M.D. or D.O. from an accredited school of medicine, • Completed residency training in an accredited program within Psychiatry Annual Base Salary: $257,000 based on 40-hour work week. The annual total value of the compensation package is estimated at $322,700, which includes the baseline salary, 401(k) contribution, and other factors as set forth below: • Projected bonus of up to $40,000 (based on previous year’s average), contingent upon meeting quality and productivity targets., • 401(k) Company Contribution (subject to IRS contribution limits):, • Employees are immediately vested in a 3% company contribution of base earnings. No employee match is required., • After one year of service, employees receive an additional 7% company contribution of base earnings. No employee match is required., • Annual Continuing Medical Education (CME) Reimbursement., • Generous Annual Paid Time Off (PTO): Vacation, Sick, Holiday, and CME days., • Medical, Prescription, and Dental Coverage: Top-tier plans with employee contributions significantly below market rates., • Life Insurance and Accidental Death and Dismemberment (AD&D) Coverage: Equal to 2x your salary (up to a maximum of $300,000) provided at no cost to you., • Additional employee-paid Voluntary Life and AD&D coverage is available for you and your family., • Loan Forgiveness: Position may be eligible for loan forgiveness through certain state or federal programs., • Medical Malpractice Coverage (equivalent to occurrence-based): Provided at no cost to the employee., • Healthcare and Dependent Care Flexible Spending Accounts (FSAs). Physician Affiliate Group of New York, P.C. (PAGNY) is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. We are committed to fostering an inclusive environment where everyone feels valued and respected. Our policies ensure equal opportunities for all. Learn more about our initiatives by visiting our Diversity, Equity, and Inclusion page. *Salary Disclosure Information: The annual base salary listed complies with the New York City law on Salary Transparency in Job Advertisements. The annual base salary listed is for full-time employment and does not include bonuses/incentive compensation or benefits. Actual total compensation depends on many factors, including experience, specialties, historical productivity, and historical collections. **The annual total value of the compensation package shown is provided as an illustration and is not guaranteed.

Job Description Overview Physician Affiliate Group of New York (PAGNY) is adding an Adult Unit Chief to the Inpatient Unit at NYC Health + Hospitals/Kings County. The Behavioral Health Center offers a comprehensive suite of services for mental health including First Episode Psychosis program, medical services, opioid treatment, substance use disorders services, a specialized unit for people with Intellectually Disability, an inpatient Extended care unit focusing on the needs of our homeless patients and prevent recidivism, ketamine assisted therapy, and inpatient and outpatient services for adults and children. Our skilled team—including adult and child and adolescent psychiatrists, psychologists, internists, nurses, social workers, creative arts therapists, peer counselors and addiction counselors delivers compassionate care in a secure environment, respecting each patient's dignity and partnering with them on their recovery journey. We also provide educational resources for patients and caregivers to enhance their understanding of mental health and addiction issues and available treatments. Our services range from psychopharmacology and various forms of psychotherapy (individual, group, and family) to specialized programs like outpatient withdrawal management, medication maintenance (including Methadone and Buprenorphine), overdose prevention, and support for personal development goals such as employment and education. Each patient receives a personalized assessment and treatment plan tailored to their specific needs, ensuring a holistic approach to recovery and health management. The hospital maintains a strong academic affiliation with SUNY Downstate Health Sciences University to maintain its high healthcare delivery standards and to provide its staff with teaching and research opportunities and the chance to work with medical students, residents and fellows very closely. The mission of NYC Health + Hospitals is to extend equally to all New Yorkers, regardless of the ability to pay, comprehensive health services of the highest quality in an atmosphere of humane care, dignity, and respect. Their Values are built on a foundation of social and racial equity and has established the ICARE standards for all staff. Responsibilities The Unit Chief collaborates with a robust interdisciplinary treatment team, including nurses, psychologists, clinical pharmacists, social workers, licensed creative arts therapists, and peer counselors to oversee daily operations of an Adult Inpatient Behavioral Health Unit. Oversee Unit Clinical Structure • Establish and oversee interdisciplinary teams and team meetings, • Ensure that community meetings and other therapeutic groups take place as scheduled, • Participate in Behavioral Codes on the unit, providing leadership to the staff and patient community, • Work with all teams on the unit to monitor length of stay and appropriate dispositions, particularly ensuring that:, • Patients who are refusing medications are taken to court promptly, • Patients who have reached their 18th day are referred for state hospitalization for continuing treatment, • Patients who would benefit from AOT are referred promptly, • Other potential barriers to discharge are identified and solved for, • Work with the medical-consultation team ensure that medical problems are properly identified and managed, • Ensure that legal statuses are up to date and accurate, • Provide clinical consultation to teams on your unit, • Assist and supervise unit psychiatrists and nurse practitioners as needed, • Monitor the need for psychiatrist assessments and other components of applications of aftercare, in such applications for appropriate housing, residential placements and state referrals, • Participate in Performance Improvement and Quality Assurance activities, including chart reviews. Educates unit staff members on Performance Improvement, Quality Assurance activities, indicators, etc. and be able to help the unit improve if their performance is below the mean for the service, • In collaboration with risk management reviews major incidents on the inpatient unit, • Assist in the preparation for surveys, • Work with the UM department to conduct MD to MD reviews and participate in any appeals to ensure authorization of inpatient stays, • Maintains focus on key strategic priorities including patient experience, access to care, increased market share, and improving financial stability Qualifications • Must be board eligible or board certified in Psychiatry, • M.D. or D.O. from an accredited school of medicine, • Completed residency training in an accredited program within Psychiatry Annual Base Salary: $257,000 based on 40-hour work week. The annual total value of the compensation package is estimated at $282,700, which includes the baseline salary, 401(k) contribution, and other factors as set forth below: • 401(k) Company Contribution (subject to IRS contribution limits):, • Employees are immediately vested in a 3% company contribution of base earnings. No employee match is required., • After one year of service, employees receive an additional 7% company contribution of base earnings. No employee match is required., • Annual Continuing Medical Education (CME) Reimbursement., • Generous Annual Paid Time Off (PTO): Vacation, Sick, Holiday, and CME days., • Medical, Prescription, and Dental Coverage: Top-tier plans with employee contributions significantly below market rates., • Life Insurance and Accidental Death and Dismemberment (AD&D) Coverage: Equal to 2x your salary (up to a maximum of $300,000) provided at no cost to you., • Additional employee-paid Voluntary Life and AD&D coverage is available for you and your family., • Loan Forgiveness: Position may be eligible for loan forgiveness through certain state or federal programs., • Medical Malpractice Coverage (equivalent to occurrence-based): Provided at no cost to the employee., • Healthcare and Dependent Care Flexible Spending Accounts (FSAs). Physician Affiliate Group of New York, P.C. (PAGNY) is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. We are committed to fostering an inclusive environment where everyone feels valued and respected. Our policies ensure equal opportunities for all. Learn more about our initiatives by visiting our Diversity, Equity, and Inclusion page. *Salary Disclosure Information: The annual base salary listed complies with the New York City law on Salary Transparency in Job Advertisements. The annual base salary listed is for full-time employment and does not include bonuses/incentive compensation or benefits. Actual total compensation depends on many factors, including experience, specialties, historical productivity, and historical collections. **The annual total value of the compensation package shown is provided as an illustration and is not guaranteed.

Annual Salary: $65k-$85k (varies depending on years of experience) An established orthopedic and spine surgery practice is seeking an experienced Medical Biller with a strong background in out-of-network billing and spine-related claims. This role is responsible for managing the full revenue cycle with a focus on accurate claims submission, payment resolution, and reimbursement optimization. Key Responsibilities • Manage end-to-end medical billing and accounts receivable for orthopedic and spine surgical cases., • Submit and track out-of-network claims to commercial payers., • Handle the Independent Dispute Resolution (IDR) process including documentation preparation, submissions, and follow-up., • Review, correct, and resubmit denied or underpaid claims in a timely manner., • Post payments, reconcile explanations of benefits (EOBs), and identify discrepancies., • Follow up aggressively on unpaid or delayed claims to ensure maximum reimbursement., • Communicate with insurance carriers regarding claim status, appeals, and payment disputes., • Work closely with the clinical and administrative teams to resolve coding and documentation issues., • Maintain strict compliance with HIPAA and billing regulations., • Generate A/R aging reports and participate in revenue cycle performance discussions., • Maintain accurate patient account records and billing documentation. Required Qualifications • Proven experience as a Medical Biller / A/R Specialist in a physician practice or surgical specialty., • Orthopedic and spine billing experience is required., • Out-of-network billing experience is required., • Independent Dispute Resolution (IDR) experience is required., • Strong understanding of commercial insurance reimbursement processes., • Excellent attention to detail, organization, and follow-through., • Ability to work independently in a fast-paced, high-volume environment., • Strong communication skills for payer and internal team interactions. — Atlas Search is a tri-state area recruitment agency, connecting new graduates, Advanced Practice Providers, Physicians and Nurse Leaders to hospitals, clinics, multi-specialty groups, nursing homes, managed care companies, private practices, and healthcare start-ups. If you would like to learn more about the opportunities we offer, please submit your CV for consideration here.

Our client, a large nonprofit hospice and palliative care company is seeking a qualified candidate to join their team.In this role, we are looking for someone who is a.New York to work in the appeals and grievances department.This is a fantastic opportunity for a registered nurse to work for a nonpr

We are seeking a dedicated Appeals Nurse to join our team! In this role, you will examine medical records and claims information for initial appeal cases, determining the medical necessity of services and ensuring compliance with Medicare coverage guidelines and regulations. Collaborate effectively