Appeals nurse jobs in North Bergen, New JerseyCreate job alerts

Overview Conducts comprehensive assessment of member UAS-NY for potential new members and existing members' conditions clinical, environmental, and social to establish an individual plan of care needed to maintain the member safe in the community. Identifies solutions that promote high quality and cost-effective health care services. Manages requests for services from providers, members, and care management team and renders clinical determinations in accordance with VNS Health Plans policies as well as applicable state and federal regulations. Works under general supervision. What We Provide • Referral bonus opportunities, • Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays, • Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability, • Employer-matched retirement saving funds, • Personal and financial wellness programs, • Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care, • Generous tuition reimbursement for qualifying degrees, • Opportunities for professional growth and career advancement, • Conduct face-to-face or telehealth UAS-NY assessments according to state guidelines, policies, procedures, and protocols., • Utilize clinical skills to assess and document all aspects of the potential members long-term community-based needs., • Communicate with members, families, providers, and other parties as needed to complete an accurate comprehensive assessment., • Utilizes VNS Health and state-approved assessment questionnaire, guidelines, and documentation as well as interviews with members, family, and care providers in decision-making., • Performs in-home assessment for members who have identified significant changes in condition since last in-home assessment; provides comprehensive review and determination of member’s needs, including completion of UAS assessment questionnaire, tasking tool, and a projected service plan. Visits include all areas serviced by VNS Health Plans including upstate and downstate counties., • Performs in-home assessment on members to determine the appropriate service plan, including completion of UAS assessment questionnaire, tasking tool, and a projected service plan. Visits include all areas serviced by VNS Health Plans., • Explains VNS Health Plan benefits, including an explanation of the member's handbook., • Ensures compliance with state and federal regulatory standards and VNS Health Plans policies and procedures., • Identifies opportunities for alternative care options and contributes to the development of a safe member centered service plan, • Consult with supervisor and others in overcoming barriers in meeting goals and objectives., • Maintains current knowledge of organizational or state-wide trends that affect member eligibility., • Coordinates with other departments, e.g. Care Management, Legal Affairs, Grievance and Appeals, Compliance, Membership Eligibility Unit, Quality as needed., • Participates in requests for out-of-network services when a member receives services outside of VNS Health Plans network services., • Keeps current with all health plan changes and updates through on-going training, coaching and educational materials., • Participates in special projects and performs other duties as assigned. Qualifications Licenses and Certifications: Current license to practice as a Registered Professional Nurse in New York State requiredCertified Case Manager preferred Education: Bachelor's Degree in nursing or equivalent work experience requiredMaster's Degree in nursing or equivalent work experience preferred Work Experience: Minimum two years of clinical assessment, homecare or hospital experience requiredExcellent organizational and time management skills, interpersonal skills, verbal and written communication skills requiredDemonstrated strong relationship management skills, including a high degree of psychological sophistication and non-aggressive assertiveness requiredDemonstrated successful conflict management skills and negotiation of “win-win” solutions requiredWorking knowledge of Microsoft Excel, Power-Point, and Word requiredKnowledge of Medicaid and/or Medicare regulations requiredWorking Knowledge of UAS-NY preferred Pay Range USD $85,000.00 - USD $106,300.00 /Yr. About Us VNS Health is one of the nation’s largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us — we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 “neighbors” who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.

Overview Conducts comprehensive assessment of member UAS-NY for potential new members and existing members' conditions clinical, environmental, and social to establish an individual plan of care needed to maintain the member safe in the community. Identifies solutions that promote high quality and cost-effective health care services. Manages requests for services from providers, members, and care management team and renders clinical determinations in accordance with VNS Health Plans policies as well as applicable state and federal regulations. Works under general supervision. • Conduct face-to-face or telehealth UAS-NY assessments according to state guidelines, policies, procedures, and protocols, • Utilize clinical skills to assess and document all aspects of the potential members long-term community-based needs, • Communicate with members, families, providers, and other parties as needed to complete an accurate comprehensive assessment, • Utilizes VNS Health and state-approved assessment questionnaire, guidelines, and documentation as well as interviews with members, family, and care providers in decision-making, • Performs in-home assessment for members who have identified significant changes in condition since last in-home assessment; provides comprehensive review and determination of member’s needs, including completion of UAS assessment questionnaire, tasking tool, and a projected service plan. Visits include all areas serviced by VNS Health Plans including upstate and downstate counties, • Performs in-home assessment on members to determine the appropriate service plan, including completion of UAS assessment questionnaire, tasking tool, and a projected service plan. Visits include all areas serviced by VNS Health Plans, • Explains VNS Health Plan benefits, including an explanation of the member's handbook, • Ensures compliance with state and federal regulatory standards and VNS Health Plans policies and procedures, • Identifies opportunities for alternative care options and contributes to the development of a safe member centered service plan, • Consult with supervisor and others in overcoming barriers in meeting goals and objectives, • Maintains current knowledge of organizational or state-wide trends that affect member eligibility, • Coordinates with other departments, e.g. Care Management, Legal Affairs, Grievance and Appeals, Compliance, Membership Eligibility Unit, Quality as needed, • Participates in requests for out-of-network services when a member receives services outside of VNS Health Plans network services, • Keeps current with all health plan changes and updates through on-going training, coaching and educational materials, • Participates in special projects and performs other duties as assigned Qualifications Licenses and Certifications: Current license to practice as a Registered Professional Nurse in New York State required. Certified Case Manager preferred. Education: Bachelor's Degree in nursing or equivalent work experience required. Master's Degree in nursing or equivalent work experience preferred. Work Experience: Minimum two years of clinical assessment, homecare or hospital experience required. Excellent organizational and time management skills, interpersonal skills, verbal and written communication skills required. Demonstrated strong relationship management skills, including a high degree of psychological sophistication and non-aggressive assertiveness required. Demonstrated successful conflict management skills and negotiation of “win-win” solutions required. Working knowledge of Microsoft Excel, Power-Point, and Word required. Knowledge of Medicaid and/or Medicare regulations required. Working Knowledge of UAS-NY preferred. Pay Range USD $85,000.00 - USD $106,300.00 /Yr. About Us VNS Health is one of the nation’s largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us — we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 “neighbors” who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.

WCS Healthcare Partners is seeking a local contract nurse RN PCU - Progressive Care Unit for a local contract nursing job in New York, New York. Job Description & Requirements • Specialty: PCU - Progressive Care Unit, • Discipline: RN, • Duration: 13 weeks, • 36 hours per week, • Shift: 12 hours, days, • Employment Type: Local Contract WCS is seeking a Stepdown RN for a Local Contract, at a prestigious hospital in New York. \n \n Job Function: \n • Day Shift and Night Shift.\n, • 3x12.\n Monitor and assess patients’ conditions, recognizing early signs of deterioration and escalating appropriately. \n\n * Administer medications, treatments, and interventions in accordance with physician orders and nursing standards. \n\n * Provide direct patient care including post-surgical management, cardiac/telemetry monitoring, and ventilator/trach support as needed. \n\n * Collaborate with physicians, interdisciplinary teams, and families to develop and implement individualized care plans. \n\n * Document assessments, interventions, and patient responses accurately in the electronic medical record (EMR). \n\n\n \n Job Requirements: \n • Graduate from an accredited School of Nursing or Bachelor's Degree in Nursing (BSN). \n, • Current RN license for the state of New York.\n, • 2 years of acute ICU/MICU RN experience is required. \n\n, • BLS & ACLS certifications from the American Heart Association.\n NURSING ● Registered Nurses (RN) ● Licensed Practical Nurses (LPN) ● Travel Nursing ● Quality Assurance/Review, Performance Improvement, HEDIS ● Nursing Leadership ● Case Management ALLIED HEALTH ● Technologists: Medical, Laboratory, Cardiac, RadTech, X-Ray ● Therapy: Physical, Occupational and Speech Therapy ● Social Work: LCSW/LMSW, Case Management, Care Coordination ● Med Support: Medical Assistants, Phlebotomy, Surgical/Sterile Techs ● Pharmacists and Pharmacy Techs ● Dental Hygienist, Dental Assistants OPERATIONS & FINANCE ● Practice Management ● Clinical Operations ● Administrative Support ● Reception, Clerical, Call Center ● Claims Appeals/Denials/Reimbursement ● Insurance Pre-Authorizations ● Medical Billing/Coding Benefits • 401k retirement plan, • Weekly pay

WCS Healthcare Partners is seeking a local contract nurse RN Acute Care for a local contract nursing job in Brooklyn, New York. Job Description & Requirements • Specialty: Acute Care, • Discipline: RN, • Duration: 13 weeks, • 36 hours per week, • Shift: 12 hours, days, • Employment Type: Local Contract WCS Healthcare is currently seeking a Medical Surgical Nurse a for a 13-week contract assignment at a Prestigious Hospital in NYC. Job Function: \n • Day Shift and Night Shift.\n, • 3x12.\n, • Prepares and administers (orally, subcutaneously, through an IV) and records prescribed medications. \n, • Reports adverse reactions to medications or treatments in accordance with the policy regarding the administration of medications by a licensed registered nurse. \n, • Educates patients on surgical procedures. Records patients’ medical information and vital signs. \n, • Monitors and adjusts specialized equipment used on patients, and interprets and records electronic display. \n, • Initiates corrective action whenever the patient. \n\n Job Requirements: \n • Graduate from an accredited School of Nursing or Bachelor's Degree in Nursing (BSN). \n, • Current RN license for the state of New York.\n, • 2 years of Emergency Room RN experience is required. \n, • BLS, ACLS, NIHSS certifications from the American Heart Association are required. \n\n \n ITAC1 \n #LI-DNP \n 42361 White Cap Search Partners Job ID #42361. Posted job title: RN - Med Surg - Local Contract About WCS Healthcare Partners With WCS Healthcare Partners, every Job Seeker grows stronger, moving one step forward with each job placement. We take the time to get to know the needs and qualifications of each Healthcare professional to match you with the right clinical setting, patient population, merging your compensation and career goals with your desired work environment. Our recruiters are experts at navigating the dynamic nature of healthcare employers to get your resume in front of the right decision makers. NURSING ● Registered Nurses (RN) ● Licensed Practical Nurses (LPN) ● Travel Nursing ● Quality Assurance/Review, Performance Improvement, HEDIS ● Nursing Leadership ● Case Management ALLIED HEALTH ● Technologists: Medical, Laboratory, Cardiac, RadTech, X-Ray ● Therapy: Physical, Occupational and Speech Therapy ● Social Work: LCSW/LMSW, Case Management, Care Coordination ● Med Support: Medical Assistants, Phlebotomy, Surgical/Sterile Techs ● Pharmacists and Pharmacy Techs ● Dental Hygienist, Dental Assistants OPERATIONS & FINANCE ● Practice Management ● Clinical Operations ● Administrative Support ● Reception, Clerical, Call Center ● Claims Appeals/Denials/Reimbursement ● Insurance Pre-Authorizations ● Medical Billing/Coding Benefits • 401k retirement plan, • Weekly pay

WCS Healthcare Partners is seeking a local contract nurse RN Wound Care for a local contract nursing job in New York, New York. Job Description & Requirements • Specialty: Wound Care, • Discipline: RN, • Duration: 13 weeks, • 36 hours per week, • Shift: 12 hours, days, • Employment Type: Local Contract WCS Healthcare is currently seeking a Registered Nurse for inpatient Wound Care for a contract assignment at a Prestigious Hospital in New York, NY. Job Function: \n • Day Shift.\n, • Recognize change in the patient’s condition and intervene appropriately \n, • Evaluate the quality and delivery of care provided by the clinical staff on unit. \n, • Works collaboratively with the health care team and makes referrals to other disciplines as indicated. \n, • Teach, counsels, and assists individuals and families to assume responsibility for prevention of complications \n, • Educate and counsel patients and their families on wound care processes and issues \n, • NY License\n, • WOCN Cert\n \n ITAC1 \n #LI-DNP \n 44001 White Cap Search Partners Job ID #44001. Posted job title: RN - Wound Care - Local Contract About WCS Healthcare Partners With WCS Healthcare Partners, every Job Seeker grows stronger, moving one step forward with each job placement. We take the time to get to know the needs and qualifications of each Healthcare professional to match you with the right clinical setting, patient population, merging your compensation and career goals with your desired work environment. Our recruiters are experts at navigating the dynamic nature of healthcare employers to get your resume in front of the right decision makers. NURSING ● Registered Nurses (RN) ● Licensed Practical Nurses (LPN) ● Travel Nursing ● Quality Assurance/Review, Performance Improvement, HEDIS ● Nursing Leadership ● Case Management ALLIED HEALTH ● Technologists: Medical, Laboratory, Cardiac, RadTech, X-Ray ● Therapy: Physical, Occupational and Speech Therapy ● Social Work: LCSW/LMSW, Case Management, Care Coordination ● Med Support: Medical Assistants, Phlebotomy, Surgical/Sterile Techs ● Pharmacists and Pharmacy Techs ● Dental Hygienist, Dental Assistants OPERATIONS & FINANCE ● Practice Management ● Clinical Operations ● Administrative Support ● Reception, Clerical, Call Center ● Claims Appeals/Denials/Reimbursement ● Insurance Pre-Authorizations ● Medical Billing/Coding Benefits • 401k retirement plan, • Weekly pay

WCS Healthcare Partners is seeking a local contract nurse RN ICU - Intensive Care Unit for a local contract nursing job in Brooklyn, New York. Job Description & Requirements • Specialty: ICU - Intensive Care Unit, • Discipline: RN, • Duration: 13 weeks, • 36 hours per week, • Shift: 12 hours, nights, • Employment Type: Local Contract WCS Healthcare is currently seeking an experienced Critical Care Nurse for a contract assignment at a highly respected hospital in NYC. Job Function: \n • Night Shift.\n, • Evaluate and continuously monitor patient progress in the ICU. \n, • Identify sudden or subtle changes in patient condition and intervene appropriately. \n, • Provide timely updates to physicians, patients, and family members. \n, • Initiate treatments, administer medications, and monitor dosing. \n, • Respond to medical emergencies and activate appropriate clinical teams. \n, • Deliver comprehensive care throughout the patient’s ICU stay. \n\n Job Requirements: \n • Graduate from an accredited School of Nursing or Bachelor's Degree in Nursing (BSN). \n, • Current RN license for the state of New York.\n, • 2 years of acute CCU RN experience is required. \n\n, • BLS & ACLS , NIHSS certifications from the American Heart Association. \n\n \n ITAC1 \n #LI-DNP \n 43385 White Cap Search Partners Job ID #43385. Posted job title: RN - ICU - Local Contract About WCS Healthcare Partners With WCS Healthcare Partners, every Job Seeker grows stronger, moving one step forward with each job placement. We take the time to get to know the needs and qualifications of each Healthcare professional to match you with the right clinical setting, patient population, merging your compensation and career goals with your desired work environment. Our recruiters are experts at navigating the dynamic nature of healthcare employers to get your resume in front of the right decision makers. NURSING ● Registered Nurses (RN) ● Licensed Practical Nurses (LPN) ● Travel Nursing ● Quality Assurance/Review, Performance Improvement, HEDIS ● Nursing Leadership ● Case Management ALLIED HEALTH ● Technologists: Medical, Laboratory, Cardiac, RadTech, X-Ray ● Therapy: Physical, Occupational and Speech Therapy ● Social Work: LCSW/LMSW, Case Management, Care Coordination ● Med Support: Medical Assistants, Phlebotomy, Surgical/Sterile Techs ● Pharmacists and Pharmacy Techs ● Dental Hygienist, Dental Assistants OPERATIONS & FINANCE ● Practice Management ● Clinical Operations ● Administrative Support ● Reception, Clerical, Call Center ● Claims Appeals/Denials/Reimbursement ● Insurance Pre-Authorizations ● Medical Billing/Coding Benefits • 401k retirement plan, • Weekly pay

WCS Healthcare Partners is seeking a local contract nurse RN Labor and Delivery for a local contract nursing job in New York, New York. Job Description & Requirements • Specialty: Labor and Delivery, • Discipline: RN, • Duration: 13 weeks, • 36 hours per week, • Shift: 12 hours, days, • Employment Type: Local Contract WCS Healthcare is currently seeking a Labor and Delivery Nurse a for a 13-week, 26-week and long-term temp contract assignments at a Prestigious Hospital in NYC. Job Function: \n • Day Shift.\n, • 3x12.\n, • Categorizes patients in the appropriate level of classification. \n, • Applies external fetal monitor and interprets fetal heart tracing and uterine activity. \n, • Implements intervention appropriately based on fetal heart rate pattern and maternal status during labor. \n, • Identifies emergency situations, observes age and notifies provider accordingly. \n, • Administers medication according to the 5 rights of safety and infection control guidelines and or per Provider's orders. \n, • Screens patients for pain during the initial assessment and reassess according to guidelines. \n\n Job Requirements: \n • Candidate MUST have two full years of Mother Baby RN experience. \n, • Bachelor's Degree in Nursing (BSN) required.\n, • Current RN license for the state of New York.\n, • BLS, ACLS, PALS & NRP certifications from the American Heart Association. \n, • Fetal Monitoring Certificate Preferred.\n NURSING ● Registered Nurses (RN) ● Licensed Practical Nurses (LPN) ● Travel Nursing ● Quality Assurance/Review, Performance Improvement, HEDIS ● Nursing Leadership ● Case Management ALLIED HEALTH ● Technologists: Medical, Laboratory, Cardiac, RadTech, X-Ray ● Therapy: Physical, Occupational and Speech Therapy ● Social Work: LCSW/LMSW, Case Management, Care Coordination ● Med Support: Medical Assistants, Phlebotomy, Surgical/Sterile Techs ● Pharmacists and Pharmacy Techs ● Dental Hygienist, Dental Assistants OPERATIONS & FINANCE ● Practice Management ● Clinical Operations ● Administrative Support ● Reception, Clerical, Call Center ● Claims Appeals/Denials/Reimbursement ● Insurance Pre-Authorizations ● Medical Billing/Coding Benefits • 401k retirement plan, • Weekly pay

Thank you for considering Progyny! Progyny is looking for a Utilization Management Coordinator to support all utilization review cases with an expanded focus on compliance and accreditation standards. This coordinator will be directly responsible for reviewing and analyzing member cases to determine the appropriateness and medical necessity to issue authorizations for treatment. This person will review clinical dashboards to understand case load, review pending cases, provide necessary documentation, and serve as the liaison between different internal and external partners including providers, payers, and compliance teams; monitor and interpret accreditation standards (e.g., URAC, NCQA) and integrate them into UM workflows, conduct internal audits and readiness assessments for accreditation reviews, collaborate with Legal and Compliance teams to update clinical guidelines and reviewer protocols, maintain awareness of licensure requirements and state-specific UM regulations. What you'll do... * Provide timely medical reviews with clinical determinations based on evidence-based criteria and necessary authorization guidelines * Conduct daily, weekly, and quarterly reporting in coordination with all service level agreements with Progyny federal and non-federal clients * Outreach and educate providers to obtain all required documentation for authorization requests * Coordinate and schedule peer-to-peer review and appeal appointments between physicians within necessary timelines; track and record quarterly compensation/reimbursement * Coordinate with Independent Review Organization to ensure the timely appeals processing and auditing of Utilization case management for specific states. * Organize and present quarterly and annual audits to ensure adherence to requirements determined for cases. * Processes all incoming and outgoing correspondence/faxes in accordance with required standards and within respective timeliness guidelines * Manage a multi-step workflow to ensure all tasks are appropriately delegated to proper workstream. * Communicate and escalate potential enhancements to both internal and external processes. * Categorize documentation while remaining in accordance with PHI / HIPAA restrictions. * Ensure UM practices align with federal and state compliance standards, including turnaround times (TAT), member notification protocols, and appeals processes. * Monitor and interpret accreditation requirements (e.g., URAC, NCQA) and integrate them into UM workflows and documentation standards. * Conduct internal audits and readiness assessments for accreditation reviews, including documentation of nurse approvals and medical necessity determinations. * Collaborate with Legal and Compliance teams to update clinical guidelines and reviewer protocols in response to regulatory changes. * Maintain licensure awareness and state-specific requirements for nurse reviewers, especially in compact and non-compact states About you... * Bachelor's degree in nursing preferred * 1+ year of fertility nursing experience * Minimum 2 years of experience in compliance or accreditation preparation preferred * Current licensed professional registered nurse * Familiarity with URAC/NCQA standards and state-specific UM regulations. * Experience in audit preparation and regulatory reporting. * Knowledge of CPT, HCPCS, ICD-10 codes and understanding of medical terminology * Strong communication and presentations skills. * Strong attention to detail * Excellent written and verbal communication skills * Ability to communicate effectively and thoughtfully with providers and patients regarding authorization requests and determinations * Ability to work independently with minimal supervision and escalate when necessary * Strong multi-tasking and prioritization skills * Experience working with CRM platforms (specifically Salesforce) and reporting / dashboard management. * Experience with CRM platforms / JIRA as it relates to bug reporting * Experience and facility working with Microsoft Office Suite (Excel, Word, PowerPoint, Outlook) * Ability and willingness to learn new programs and platforms to optimize UM workflow/Member experience. * Utilization management experience preferred Please note: This is not a digital nomad or remote international position; candidates must be based in the United States. Progyny is unable to provide visa sponsorship for this position. Candidates must be authorized to work in United States without the need for sponsorship, now or in the future. About Progyny: Progyny (Nasdaq: PGNY) is a global leader in women's health and family building solutions, trusted by the nation's leading employers, health plans and benefit purchasers. We envision a world where everyone can realize dreams of family and ideal health. Our outcomes prove that comprehensive, inclusive and intentionally designed solutions simultaneously benefit employers, patients and physicians. Our benefits solution empowers patients with concierge support, coaching, education, and digital tools;provides access to a premier network of fertility and women's health specialists who use the latest science and technologies; drives optimal clinical outcomes; and reduces healthcare costs. Our mission is toempower healthier, supported journeys through transformative fertility, family building and women's health benefits. Headquartered in New York City, Progyny has been recognized for its leadership and growth as a TIME100 Most Influential Company, CNBC Disruptor 50, Modern Healthcare's Best Places to Work in Healthcare, Forbes' Best Employers, Financial Times Fastest Growing Companies, Inc. 5000, Inc. Power Partners, and Crain's Fast 50 for NYC. For more information, visit ___. Our perks: • Family friendly benefits: Paid family and parental leave, preconception, fertility and family building benefits (including egg freezing, IVF, and adoption support), family and pet care fund, and Parents' Employee Affiliation Group, • Menopause and midlife care, • Health, dental, vision and life insurance options for employees and family, • Free in-person, virtual and text-based mental health and wellness support, • Paid time off, including vacation, sick leave, personal days and summer flex time, • Company equity, • Bonus program, • 401(k) plan with company match, • Access to on-demand legal and financial advice, • Learning and development programs to help you grow professionally and a mentorship program, • Company social eventsto include annual volunteer day and donation matching, • Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office In compliance with New York City's Wage Transparency Law, the hourly salary [wage] range for NYC-based applicants is: $35 - 45/hour. There are a variety of factors that go into determining a salary range, including but not limited to external market benchmark data, geographic location, and years of experience sought/required. Progyny offers a total compensation package comprised of base salary, cash bonus, and equity. Progyny is proud to be anEqual Opportunity and Affirmative Action employer.We respect and seek to empower each individual and support the diverse cultures, perspectives,skillsand experiences within our workforce. All qualified applicants will receive consideration for employment without regard to race, creed, color, religion, sex, sexual orientation, gender identity or expression, national origin, disability, age, genetic information, marital status, pregnancy or related condition, status as a protected veteran, criminal history consistent with legal requirements or any other basis protected by law. If you are an individual with a disability and need assistance or an accommodation during the recruiting process, please send an e-mail to ___. #LI-EH1

Job details About Us: The people of Memorial Sloan Kettering Cancer Center (MSK) are united by a singular mission: ending cancer for life. Our specialized care teams provide personalized, compassionate, expert care to patients of all ages. Informed by basic research done at our Sloan Kettering Institute, scientists across MSK collaborate to conduct innovative translational and clinical research that is driving a revolution in our understanding of cancer as a disease and improving the ability to prevent, diagnose, and treat it. MSK is dedicated to training the next generation of scientists and clinicians, who go on to pursueour missionat MSK and around the globe. Job Description Exciting Opportunity at MSK: Are you passionate about using your Case Management experience to support Oncology Patients? The MSK Case Management Department is made up of Registered Nurses (RNs), Licensed Practical Nurses (LPNs) and support staff. In this role, you will be responsible for evaluating and responding to clinical and administrative denials referred to Case Management Department for appeal. You will participate in the daily management of the denial through resolution after the appeal is filed. You will perform special chart reviews to support strategic planning initiatives, while working with multidisciplinary team and acts as a liaison to insurance carriers and staff. Role Overview: * Provide case management for a caseload of Oncology patients * Assess discharge planning needs at the patient's admission * Perform regular concurrent review on all patients and coordinate all needed services including home care to facilitate the safe and timely transition to the next level of care and to follow selected patients in the outpatient setting * Act as part of a multidisciplinary team to provide continuity of care throughout various stages of treatment and follow-up * Connect with physicians and clinical nursing staff regarding ongoing patient care * Work with insurance carriers and MSKCC billing departments to initiate appeals and acquire authorizations for treatment Key Qualifications: * Current NYS Registered Nurse License/Registration and BSN preferred * At least 2-3 years of clinical hospital nursing experience * Managed care/UR/CM experience strongly preferred * Knowledge of state and federal regulations that govern health insurance coverage * Knowledge of Microsoft: Outlook, Word, Excel, and PowerPoint Core Skills: * Excellent interpersonal, decision-making, and communication skills * Strong decision-making and negotiation skills Additional Information: * Schedule: Five 8-hour shifts, Monday to Friday with on-call responsibilities; rotating weekend coverage * Location:1275 York Avenue, New York, New York * Reporting to: Supervisor, Case Management Helpful Links: * * Pay Range: $125,400.00 - $200,700.00 FSLA Status: Exempt Closing: At MSK, we believe in fair, competitive pay that reflects your job, experience, and skills. MSK is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sexual orientation, national origin, age, religion, creed, disability, veteran status or any other factor which cannot lawfully be used as a basis for an employment decision. Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Serves as a clinical resource for utilization management, CMOs, phy

Job details About Us: The people of Memorial Sloan Kettering Cancer Center (MSK) are united by a singular mission: ending cancer for life. Our specialized care teams provide personalized, compassionate, expert care to patients of all ages. Informed by basic research done at our Sloan Kettering Institute, scientists across MSK collaborate to conduct innovative translational and clinical research that is driving a revolution in our understanding of cancer as a disease and improving the ability to prevent, diagnose, and treat it. MSK is dedicated to training the next generation of scientists and clinicians, who go on to pursueour missionat MSK and around the globe. Exciting Opportunity at MSK: Are you passionate about making a meaningful impact on the care journey of oncology patients? The MSK Case Management Department-comprised of Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and support staff-plays a critical role in ensuring patients receive the right care at the right time. In this role, you will help remove barriers to care, support timely access to treatment, and advocate for patients navigating complex insurance and care transitions, contributing directly to high-quality outcomes and continuity of care. Role Overview: * Provide case management for a defined caseload of Oncology patients, ensuring appropriate level of care and timely discharge planning * Assess discharge planning needs at admission and throughout hospitalization, identifying and addressing barriers to discharge * Perform regular concurrent reviews to ensure medical necessity and appropriate level of care, coordinating services to support safe, timely transitions * Act as part of a multidisciplinary team to ensure continuity of care across treatment phases * Collaborate with physicians and clinical nursing staff regarding patient care, level of care determination, and discharge readiness, including required clinical documentation * Work with insurance carriers and MSK billing departments to obtain authorizations, manage denials, and support appeals for treatment coverage Key Qualifications: * Active New York State Registered Nurse (RN) license/registration * Bachelor of Science in Nursing (BSN) * Minimum of 2-3 years of clinical hospital nursing experience * Minimum of 2-3 years of Case Management, Utilization Review (UR), or Managed Care experience * Knowledge of state and federal regulations governing health insurance coverage and reimbursement Core Skills: * Strong interpersonal, communication, and collaboration skills * Sound clinical judgment with strong decision-making and negotiation abilities * Ability to manage a caseload, prioritize competing demands, and maintain accurate documentation Additional Information: * Schedule: Four 10-hour shifts Friday to Monday (Saturday and Sunday Required) * Location:1275 York Avenue, New York, New York Helpful Links: * * Pay Range: $125,400.00 - $200,700.00 FSLA Status: Exempt Closing: At MSK, we believe in fair, competitive pay that reflects your job, experience, and skills. MSK is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sexual orientation, national origin, age, religion, creed, disability, veteran status or any other factor which cannot lawfully be used as a basis for an employment decision. Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

We are looking for a Clinical Appeals Nurse to join our team to train AI models.

Job DescriptionAbout Baba Baba is rebuilding healthcare for older adults. Navigating healthcare can be overwhelming. By 2030, over 65 million older adults will make up nearly a quarter of the U.S. population, creating one of the largest and most urgent challenges in healthcare. Baba makes it easier by pairing older adults with an expert advocate (usually a nurse or social worker) who coordinates their care. Baba's insurance-covered advocates have supported thousands of families by writing insurance appeals, researching specialists, getting medical equipment and cheaper medications, and scheduling appointments. Baba's investors include General Catalyst, Genius Ventures, Soma Capital, and Ground Up Ventures, along with angel investors who were founders or executives of leading companies. More than 50% of the Baba team are former founders, with backgrounds from MIT, Carnegie Mellon, Stripe, Palantir, and Liquid AI. About the Role Baba is seeking an Operations Engineer to scale the infrastructure Baba uses to manage its clinical network. You will engineer AI-driven systems to manage the daily workflows of a marketplace of advocates and providers, creating the benchmarks and automated QA loops required to onboard millions of patients without sacrificing quality of service. You will report to the founder and work at the intersection of product, operations, and system design. What You’ll Do * Design the technical and operational infrastructure to manage a large-scale network of providers and advocates. * Build data-driven frameworks to audit patient outcomes and expert performance. Shift QA from manual oversight to automated, scalable monitoring. * Deconstruct clinical processes into lean, repeatable workflows to maximize the efficiency of human-in-the-loop systems. * Translate operational bottlenecks into product requirements. Collaborate with Engineering to ship tools that eliminate manual friction. * Navigate the trade-offs between clinical rigor, medical regulation, and system speed. Who You Are * High-Agency & Meticulous: You have a "zero-defect" mindset. You build systems to ensure nothing falls through the cracks and take total ownership of system reliability. * Systems Thinker: You can map complex, multi-user journeys and simplify them into structured data and logical flows. * Pragmatic & Fast: You prioritize "done" over "perfect" but "correct" over "easy." You thrive in high-pressure, ambiguous environments. * Analytical Communicator: You argue from first principles and can defend your design logic with data and product intuition. * Willing to "Sweep the Corners": You are equally comfortable answering a patient customer support ticket as you are leading a high-level strategic review. No task is below you. What You Need * Quantitative undergraduate degree (Engineering, CS, Math, etc.) is required. * Proven success in high-stakes environments—ideally as a former founder or within Investment Banking/Private Equity. * Exceptional attention to detail Benefits * Medical, dental & vision insurance coverage * 401k * Flexible PTO * Free lunch & dinner in office * Relocation support to NYC (as needed)

Job DescriptionAbout Baba Baba is rebuilding healthcare for older adults. Navigating healthcare can be overwhelming. By 2030, over 65 million older adults will make up nearly a quarter of the U.S. population, creating one of the largest and most urgent challenges in healthcare. Baba makes it easier by pairing older adults with an expert advocate (usually a nurse or social worker) who coordinates their care. Baba's insurance-covered advocates have supported thousands of families by writing insurance appeals, researching specialists, getting medical equipment and cheaper medications, and scheduling appointments. Baba's investors include General Catalyst, Genius Ventures, Soma Capital, and Ground Up Ventures, along with angel investors who were founders or executives of leading companies. More than 50% of the Baba team are former founders, with backgrounds from MIT, Carnegie Mellon, Stripe, Palantir, and Liquid AI. About the Role Baba is seeking a Fullstack Engineer to own the end-to-end development lifecycle for new platform capabilities and integrations with other systems. You'll own core systems end-to-end — from voice AI infrastructure to the internal tools our advocates and providers use daily. As we scale from thousands to millions of patients, you'll design the APIs, data pipelines, and product surfaces that make that possible without sacrificing quality of care. What You’ll Do * Build and maintain the web applications, APIs, and backend services that power Baba's patient advocacy platform. * Design and implement automated QA and monitoring systems to audit patient outcomes and advocate performance at scale. * Develop internal tools and dashboards that streamline clinical workflows, replacing manual processes with reliable, scalable software. * Architect data models and pipelines to support a growing marketplace of advocates, providers, and patients. * Collaborate directly with the founder and clinical team to translate operational bottlenecks into shipped product. Who You Are * Strong builder: You have 2+ years of professional experience building and shipping web applications. You're comfortable owning features end-to-end, from database schema to UI. * Systems thinker: You can map complex, multi-user workflows into clean data models and logical service boundaries. * Pragmatic and fast: You prioritize shipping over perfection, but you don't cut corners on correctness. You thrive in early-stage ambiguity. * High-agency: You take ownership of problems, not just tickets. When something breaks at midnight, you fix it. * Willing to sweep the corners: You're equally comfortable debugging a production issue, answering a patient support ticket, or whiteboarding system architecture. No task is below you. What You Need * 2+ years of professional engineering experience (excluding internships) in relevant roles at tech and product-driven companies * Are proficient in one or more backend languages (e.g., Python, Go, Rust, Typescript or similar) and distributed systems concepts. * Care deeply about reliability, safety, and performance in production environments. * Interest in AI/ML (direct experience not required) * Proven ability to thrive in fast-growing, product-driven companies by effectively navigating loosely defined tasks and managing competing priorities or deadlines. * Bonus: Former founder, or early engineer at a startup who has built a product from scratch Benefits * Medical, dental & vision insurance coverage * 401k * Flexible PTO * Free lunch & dinner in office * Relocation support to NYC (as needed)

Job DescriptionAbout Baba Baba is rebuilding healthcare for older adults. Navigating healthcare can be overwhelming. By 2030, over 65 million older adults will make up nearly a quarter of the U.S. population, creating one of the largest and most urgent challenges in healthcare. Baba makes it easier by pairing older adults with an expert advocate (usually a nurse or social worker) who coordinates their care. Baba's insurance-covered advocates have supported thousands of families by writing insurance appeals, researching specialists, getting medical equipment and cheaper medications, and scheduling appointments. Baba's investors include General Catalyst, Genius Ventures, Soma Capital, and Ground Up Ventures, along with angel investors who were founders or executives of leading companies. More than 50% of the Baba team are former founders, with backgrounds from MIT, Carnegie Mellon, Stripe, Palantir, and Liquid AI. About the Role Baba is seeking a Product Designer to design the Baba platform from the ground up – building intuitive, AI-driven, data-rich dashboards for patients, nurses, and care teams. You'll work directly with the founder and eng team in a fast-moving, early-stage environment. What You’ll Do * Design information-dense dashboards for both patients and providers. * Create intuitive user flows and features for healthcare workflows. * Collaborate closely with engineering and product to ship quickly and iterate. Balance usability, regulation, and technical constraints. * Design adjacent touchpoints (web pages, marketing assets, etc.) to support the business Who You Are * Senior designer comfortable as a team of one; makes strong, independent decisions. * Systems thinker who can simplify complexity and design for multiple user types. * Entrepreneurial, flexible, and pragmatic – thrives in ambiguity and can move fast. * Collaborative communicator with clear design rationale and product intuition. * Previously worked at companies like Mercury, Anthropic, Stripe, Ramp, Notion, Clay, Palantir, Commure, Abridge, Carbon Health, Forward, Ro, Cityblock — or other strong product-led, system-oriented orgs. What You Need * Full-stack product design (ideally in B2B SaaS, health-tech, or data-heavy products). * Strong UX/UI execution with experience in dashboard or workflow design. * Ability to design within tight constraints (technical, regulatory, timeline). Benefits * Medical, dental & vision insurance coverage * 401k * Flexible PTO * Free lunch & dinner in office * Relocation support to NYC (as needed)

A healthcare technology company in the United States seeks a Clinical Appeals Nurse to train AI models.This role involves evaluating AI chatbot outputs for accuracy and providing them with complex healthcare-related problems.The ideal candidate will thrive in a flexible work environment, with the op

A healthcare technology company is seeking a Clinical Appeals Nurse to enhance AI models by providing complex healthcare challenges and assessing accuracy.The position is flexible and allows you to choose projects that align with your expertise.Successful candidates will exhibit proficiency in healt

Job Description Empowerment Academy has three campuses, an Elementary School, Middle School, and High School. We are hiring a School Nurse to serve all of our students. You will be working on a team of 4 nurses and you will primarily be based out of the Middle School. While we would love for someone to begin ASAP, we would also consider someone who can begin in September. Salary: $72,000-$87,000 Hours: 7:15am-3:45pm (may vary by campus) Why Our School is Special Empowerment Academy is a highly successful charter school that truly supports its teachers and staff. We serve a student mix that is among the most diverse in America while enjoying the cultural vibrance of Jersey City, Hoboken and New York City. If this appeals to you, then apply today! We have achieved academic success without burning out our staff by meshing an effective education program with effective staff supports and professional development. We truly value our faculty and work hard to control other costs so we can focus our resources on supporting them. In fact, throughout our history, we have annually increased faculty salaries by more than at other public schools and now, among those with similar experience, OUR FACULTY MEMBERS ARE AMONG THE HIGHEST PAID IN NEW JERSEY. New Jersey charter schools ARE public schools. Our staff is part of the Pension in New Jersey. Nurse Responsibilities • Carrying out written orders of the medical home and standing orders of the school physician;, • Conducting health screenings which include height, weight, blood pressure, hearing, vision and scoliosis;, • Monitoring vital signs and general health status for emergent issues for students suspected of being under the influence of alcohol and controlled dangerous substances;, • Maintaining student health records;, • Recommending to the school principal those students who shall not be admitted to or retained in the school building based on a parent‘s failure to provide evidence of the child‘s immunization according to specified schedules;, • Annually reviewing student immunization records to confirm with the medical home that the medical condition for the exemption from immunization continues to be applicable;, • Recommending to the school principal exclusion of students who show evidence of communicable disease;, • Directing and supervising the emergency administration of epinephrine and training school staff designated to serve as delegates;, • Administering asthma medication through use of a nebulizer;, • Directing and supervising the health services activities of any school staff to whom the certified School Nurse has delegated a nursing task;, • When appropriate, transmitting a summary of relevant health and medical information to a Child Study Team;, • Writing and updating, at least annually, the individualized health care plan and the individualized emergency healthcare plan for students’ medical needs and instructing staff as appropriate;, • Implementing and assisting in the development of healthcare procedures for students in the event of an emergency;, • Instructing teachers on communicable disease and other health concerns;, • Providing other nursing services consistent with the School Nurse‘s certification;, • Collaborating with staff in grade-level and department planning meetings, and in professional development activities;, • Helping with school-wide activities and providing supervision of students during class, breaks, and meals when needed;, • Any other tasks dictated by the School Principal related to student health and wellness;, • Assisting with tasks necessary for the successful and orderly functioning of the school (such as hallway supervision, arrival/departure transitions, field trips, and other such duties as the school leadership may request from staff); and, • The Candidate needs to possess School Nurse certification in New Jersey. (We would consider someone with an RN/BSN who is looking to enroll in a School Nurse Certification program immediately upon being hired.), • School Nurse experience preferred., • Excellence in communication and organization skills., • Demonstrated ability to work effectively with students, families, staff and community with diverse backgrounds., • Demonstrated aptitude or competence for assigned responsibilities., • Health Care Plan (Medical, Dental & Vision), • Retirement Plan, • Paid Time Off (Vacation, Sick & Public Holidays), • Family Leave (Maternity, Paternity), • Short Term & Long Term Disability, • Training & Development As an equal opportunity employer, Empowerment Academy hires without consideration to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, or disability. INDSUPPORT

Licensed Practical Nurse (LPN) Pediatric Home Health. In this role, you'll support pediatric patients with skilled nursing needs while working closely with a registered nurse and clinical leadership. A clinical team focused on nurse safety and success.

Licensed Practical Nurse (LPN) – Pediatric Home Health. In this role, you'll support pediatric patients with skilled nursing needs while working closely with a registered nurse and clinical leadership. A clinical team focused on nurse safety and success.

Licensed Practical Nurse (LPN) – Pediatric Home Health. In this role, you'll support pediatric patients with skilled nursing needs while working closely with a registered nurse and clinical leadership. A clinical team focused on nurse safety and success.

Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of between $25 / hr.There is no payment required in order to apply or to work as an In-Home Usage Tester.You

Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Serves as a clinical resource for utilization management, CMOs, phy

This is an entry level position in the Appeals Department that reviews, analyzes and processes non-complex pre-service and post service grievances and appeals requests from customer types (i. Medical Claims/ Appeals Specialist. The analyst may serve as a liaison between grievances & appeals and /or

We are seeking a Virtual Customer Service Representative to join our team! You will be responsible for helping customers by providing product and service information and resolving technical issues.Responsibilities: • Handle customer inquiries and complaints • Provide information about the produc

Seeking participants for Focus Group and market research studies.Work part-time from home and earn up to $750 per week.Register to see if you are eligible.Administrative Assistant admin experience not required.Remote Work From Home Administrative Assistant Admin - Part Time Market Research Panelists

Seeking participants for Focus Group and market research studies.Work part-time from home and earn up to $750 per week.Register to see if you are eligible.Customer service representative agent experience not required.Remote Work From Home Customer Service Representative Agent - Part Time Market Rese

Seeking participants for Focus Group and market research studies.Work part-time from home and earn up to $750 per week.Register to see if you are eligible.Administrative Assistant admin experience not required.Remote Work From Home Administrative Assistant Admin - Part Time Market Research Panelists

A healthcare organization is hiring Field Case Managers (RN or LPN) for statewide New Jersey.These independent contractor roles allow flexibility in scheduling for managing cases in workers' compensation.Applicants should have at least one year of relevant experience and a current nursing license.Re

Seeking participants for Focus Group and market research studies.Work part-time from home and earn up to $750 per week.Register to see if you are eligible.Administrative Assistant admin experience not required.Remote Work From Home Administrative Assistant Admin - Part Time Market Research Panelists

Current NYS Registered Nurse license.

Seeking participants for Focus Group and market research studies.Work part-time from home and earn up to $750 per week.Register to see if you are eligible.Administrative Assistant admin experience not required.Remote Work From Home Administrative Assistant Admin - Part Time Market Research Panelists

WCS Healthcare represents an amazing Group Home/Residence working with the OPWDD Population, and we are excited to partner with a very well-known social services organization seeking a dedicated Registered Nurse (RN) to join their growing team in the Bronx, NY!.