Trabajos appeals nurse en North Bergen, New JerseyCrear alertas

Job DescriptionClinical Executive Director – Pediatrics (RN) Location: Rochelle Park, NJ Travel Required: New York (Manhattan & Long Island) and Connecticut Offices Salary: $120,000–$130,000 annually (Based on experience)Join Our Growing Pediatric Division! Affirmed Home Care, a premier concierge private-pay home care agency, is expanding our Pediatric Division and is seeking an experienced, dynamic, and motivated Clinical Executive Director (RN) to lead pediatric clinical operations across New Jersey, New York, and Connecticut. This is an exciting opportunity to join our leadership team and help shape one of the region's premier pediatric home care programs. The ideal candidate is an experienced Registered Nurse leader who is passionate about pediatric home care, operational excellence, quality outcomes, and developing high-performing clinical teams. This position is based in Rochelle Park, New Jersey, with regular travel to our Manhattan, Long Island, and Connecticut offices to provide clinical leadership, operational oversight, staff development, and support continued growth throughout the Pediatric Division. The Clinical Executive Director will oversee pediatric clinical operations, supervise skilled nursing teams, manage high-acuity and VIP pediatric cases, ensure regulatory compliance, and partner with leadership to deliver exceptional patient and family-centered care. Requirements • Active Registered Nurse (RN) license, • 5+ years of pediatric home care leadership experience preferred, • Ability to travel between NJ, NY, and CT offices, • Flexibility to support occasional evenings and weekends as business needs require Key Responsibilities Clinical Leadership & Team Oversight • Lead the Pediatric portion of daily stand-up meetings; collect and present updates from staff unable to attend, • Provide nursing updates during team huddles, with emphasis on high-revenue and skilled nursing case needs, • Provide direction, competency, coaching, and real-time problem-solving support to nursing team members, • Provide immediate support for urgent clinical or operational matters Clinical Operations & Case Management • Oversee both caregiver and skilled nursing pediatric cases to ensure service excellence, • Provide hands-on clinical support for cases designated as VIP priority, • Ensure all assessments, start of care visits, and routine visits are completed as scheduled, • Monitor nursing staff compliance with visit requirements and ensure corresponding progress notes are completed, • Ensure nurses are scheduled to be a at start of cares and needed visits, • Manage a caseload of pediatric client’s along with supervising and supporting NY and CT pediatric nurses. Documentation & Regulatory Compliance • Ensure timely completion and accuracy of clinical documentation, including:, • 485s (Plans of Care), • IPOs (Interim Physician Orders), • Assessments and visit notes, • Ensure corrections are completed promptly in response to compliance or QA review, • Ensure supervisions and reports are being provided to staff, • Review start of care and discharge documentation for completeness and compliance, • Conduct regular self-audits of clinical charts to ensure adherence to DOH standards and agency policy Quality Assurance & Performance Improvement (QAPI) • Participate in Quality Assurance (QA/QAPI) meetings and initiatives, • Review overdue and upcoming assessments to ensure compliance with regulatory timelines, • Monitor infection control reporting and ensure timely submission by nursing staff, • Ensure incident reports are completed, reviewed, and escalated appropriately, • Track and trend documentation, compliance, and performance issues, implementing corrective actions as needed Education & Staff Development • Participate in and/or oversee orientation for new nursing staff, • Support ongoing competency validation and clinical education initiatives, • Assist in the vetting and evaluation of pediatric staff to ensure clinical competency and alignment with agency standards Reimbursement, Authorizations & Clinical Documentation Responsibilities • Manage and track all insurance authorizations, reauthorizations, and Single Case Agreements (SCAs) to ensure uninterrupted patient services., • Monitor authorization utilization and proactively initiate renewals prior to expiration to prevent gaps in care., • Coordinate with physicians, hospitals, discharge planners, case managers, and insurance representatives to obtain and maintain required approvals., • Prepare, complete, and submit Letters of Medical Necessity (LMNs) and all supporting clinical documentation required for authorization requests, appeals, and continued service approvals., • Review physician orders, Plans of Care (485s), Interim Physician Orders (IPOs), nursing assessments, and visit documentation to ensure medical necessity is accurately supported., • Collaborate with clinical leadership and field staff to obtain updated assessments, physician documentation, and supporting records necessary for payer approval., • Maintain accurate tracking logs for Medicaid, Medicare, Managed Medicaid, commercial insurance authorizations, and Single Case Agreements, ensuring all expiration dates, renewal timelines, and payer requirements are met., • Coordinate recertification documentation and ensure all required clinical records are completed, signed, and submitted within payer and regulatory timeframes., • Prepare and organize documentation for Medicare, Medicaid, Managed Care, Department of Health (DOH), Recovery Audit Contractor (RAC), Unified Program Integrity Contractor (UPIC), and other payer or regulatory audits., • Respond to payer requests for additional documentation, medical records, and audit inquiries within established deadlines., • Conduct routine documentation reviews to verify that nursing notes, assessments, supervisory visits, physician orders, and Plans of Care support ongoing medical necessity and reimbursement., • Identify documentation deficiencies and work directly with nursing staff and providers to obtain corrections prior to claim submission or audit review., • Monitor payer policy updates, Medicare Conditions of Participation, Medicaid regulations, and managed care requirements, ensuring agency compliance with reimbursement guidelines., • Develop and maintain reports tracking authorization status, pending renewals, audit requests, denials, appeals, and reimbursement trends., • Participate in Quality Assurance (QA/QAPI) meetings by identifying documentation trends, authorization issues, denial patterns, and opportunities for process improvement., • Educate clinical staff on documentation standards that support medical necessity, reimbursement, recertification, and regulatory compliance., • Collaborate with Billing, Compliance, Clinical Operations, Intake, Scheduling, and Physician Offices to facilitate efficient authorization and reimbursement workflows., • Assist with payer appeals by gathering supporting documentation, preparing appeal packets, and coordinating physician involvement when necessary., • Ensure all documentation complies with Medicare, Medicaid, payer-specific, state, federal, accreditation, and agency requirements Operational Oversight • Manage on-call schedules and review on-call logs to ensure appropriate coverage and follow-up for NY and CT pediatric cases, • Collaborate with interdisciplinary teams (scheduling, compliance, HR) to ensure continuity of care and operational efficiency, • Coordinate and schedule nursing staff for orientation, ensuring all required competencies and training requirements are completed in accordance with agency standards, • Monitor and address nursing-related issues during off-hours through email and remote communication to ensure continuity of operations, • Provide coverage support for staffing gaps, ensuring uninterrupted patient care services, • Manage a designated caseload of Pediatric clients, ensuring a high level of service quality and client satisfaction, • Participate in and support the initiation (start of care) for VIP and high-acuity/high-tech pediatric cases as needed, • Assist with performance management, including disciplinary actions and corrective measures for Pediatric nursing staff in collaboration with leadership, • Serve as an advocate for Pediatric nursing staff, promoting team cohesion, engagement, and a positive work environment, • Perform additional duties and responsibilities as assigned to support clinical operations and organizational goals Why Join Affirmed Home Care? Competitive Compensation $120,000 – $130,000 annually (Compensation based on experience) Comprehensive Benefits • Generous PTO, • Health, dental, and vision insurance, • 401(k) with company match Career Growth • Leadership development opportunities, • Advancement within a growing organization Supportive Culture • Collaborative, team-oriented environment, • A company committed to excellence, compassion, and quality care Apply Today Ready to take the next step in your nursing leadership career? Submit your resume today and join a company that values professional growth, clinical excellence, and compassionate care. Affirmed Home Care is an Equal Opportunity Employer. Powered by JazzHR KeLwMMHkeR

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)

The Case Manager (CM) will be responsible for all aspects of case management for an assigned group of inpatients to determine the appropriateness of the admission and continued stay, assist in the development of the plan of care; ensure that the plan is implemented in a timely basis and identify the expected length of stay (ELOS). The CM works collaboratively with physicians, social workers, clinical nurses, home care services, and other members of the interdisciplinary team as needed. The CM actively participates in specific clinical initiatives focused on reducing the length of stay (LOS), improved efficiency, quality and resource utilization. Assignment will be by units/clinical areas of practice and may require responsibility on other units/services Principle Duties and responsibilities include, but are not limited to: • Reviews all new admissions to identify patients where utilization review, discharge planning, and/or case management will be needed using standardized criteria to achieve optimal patient outcomes and appropriate reimbursement for the organization., • Performs continued stay reviews utilizing standardized criteria to justify continued inpatient stay., • Collaborates with Physician and other clinicians to expedite diagnostic testing, treatment and consultations., • Documents all clinical reviews in Canopy., • Supports the mission, vision, philosophy and goals of the Medical Center. Case Management: The CM process will include: • Assessment of the patient's clinical, psychosocial, and functional status in collaboration with the interdisciplinary team., • Identification and documentation of variances affecting the LOS and the discharge planning process., • Conducts follow-up of any delays in treatment or reporting of results., • Planning/developing specific goals with the physician, interdisciplinary team, and the patient and/or family., • Implementation and coordination of specific activities, strategies, and interventions to move the patient through the continuum of care., • Documentation of outcomes achieved and identified internal and external barriers., • Identifies reasons for readmissions and collaborates with interdisciplinary team on strategies to reduce readmission rate., • Appropriately identifies and refers cases to the physician advisor to support timely progression of patients along the continuum of care and (appropriate) discharge planning., • Interacts with patient/family to discuss plan of care and coordination of services based on clinical needs and available resources. Utilization Review: • Maintains a working knowledge of the UR requirements of each payor within the patient population;, • Provides the clinical information requested by the managed care companies as part of the concurrent review in a timely fashion., • Provides clinical information requested by the managed care companies in accordance with contractual agreements., • Works collaboratively with physicians and managed care companies on concurrent denial appeals, • Communicates clinical information to the payor, as needed, coordinating direct communication between physician and payor Medical Director as required., • In psychiatry, the CM will document UR notes in the medical record as per OMH guidelines. Discharge Planning: • Responsible for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission)., • Obtains authorizations from managed care companies for post-discharge services., • Assesses for clinical readiness and completes the Hospital and Community Patient Review Instrument (PRI) for patients requiring Residential Health Care Facility placement., • Liaison with financial department for current insurance coverage. Collaborates and participates in the appeals process with all members of the interdisciplinary team. Collaborative Relationships: • Develops and maintains effective working relationships with interdisciplinary team and Case Managers within managed care organizations. Participates in nursing orientation. Interfaces with other departments in the Medical Center. • Bachelors Degree in Nursing; Masters preferred., • Previous experience as in homecare, long term care or utilization review preferred., • Discharge Planner or Case Manager preferred., • Manager or a minimum of 3-5 years experience as a RN in an acute care setting., • Current NYS RN nursing license., • CCM certification preferred. Re-credentialing of CCM status expected., • PRI Certification (to be obtained within 1 year) Strength through Unity and Inclusion The Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai's unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. We encourage all team members to actively participate in creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual. At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally. Explore this opportunity and be part of the next chapter in our history. About the Mount Sinai Health System: Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients' medical and emotional needs at the center of all treatment. The Health System includes more than 9,000 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report's "Best Children's Hospitals" ranks Mount Sinai Kravis Children's Hospital among the country's best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 11 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek's "The World's Best Smart Hospitals" ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally. • Job Identification 3037386, • Job Category Professional, • Posting Date 06/16/2026, 03:55 PM, • Job Schedule Full time, • Job Shift Day, • Locations 1111 Amsterdam Ave, New York, NY, 10025, US, • MapTiler OpenStreetMap contributors Legend Jobs at a location Group of locations MapTiler OpenStreetMap contributors | Oracle Corporation Terms Legal Notices Use control and scroll to zoom the map Use two fingers to move the map 1111 Amsterdam Ave, New York

Job Description Quality Management Nurse - Home Healthcare Agency Located in Brooklyn, NY Mon-Fri; 8:30AM-5:00PM Salary: Up to $110K per year APPLY TODAY! Qualifications: • Must have NYS RN License, • A minimum of two years’ experience in home care, • Must have HCHB experience, • Excellent verbal, written & communications skills, • Knowledgeable regarding State and Federal regulations for Home Care Agency, • Excellent verbal and written communication skills Responsibilities: Ensuring regulatory compliance and continuous performance improvement. Responsibilities include appeals preparation, grievance tracking, patient satisfaction analysis, and competency evaluations. The ideal candidate demonstrates professionalism, attention to detail, and a commitment to excellence in patient care and staff support. #7350

Duet empowers Nurse Practitioners (NPs) to tackle the primary care crisis by leading their own practices, closing the gap in access while keeping care local. We're a well-funded seed-stage company led by experienced entrepreneurs and Nurse Practitioners, and backed by investors like Lerer Hippeau and Kairos. We're building a vertically integrated platform to help NP practices thrive as independent businesses. From patient engagement to revenue forecasting, from care delivery to community building, our solutions are driven by data and designed to let NPs focus on what matters most: caring for their communities. About the Role We're looking for an RCM Strategy & Operations Manager to be a trusted partner to our NP practices on everything billing and revenue. Reporting to the Head of RCM, you'll be the person who keeps the financial engine running - monitoring performance, resolving issues, and making sure practices never have to wonder what's happening with their revenue cycle. Equal parts operational expert, clear communicator, and proactive problem-solver, you'll own the day-to-day RCM health of a portfolio of practices, translating complex billing data into plain-English updates, flagging issues before they snowball, and collaborating across Duet's internal teams to keep everything moving. This role is perfect for someone who thrives in a fast-paced environment, takes ownership seriously, and genuinely cares about helping independent practices succeed. What You'll Do • RCM Monitoring & Performance: Track key health indicators (denial rates, A/R aging, claim submission lag, and collections trends) and surface issues before they become problems. Maintain accurate, up-to-date tracking of open items and practice-level RCM status., • Billing Issue Resolution: Investigate and resolve billing issues across the full claim lifecycle, from submission through payment posting, denial resolution, and appeals. Nothing falls through the cracks on your watch., • Practice Communication: Communicate proactively with practices via email and video, translating complex billing data into clear, actionable updates. You're the person they trust to tell them what's happening and what to do about it., • Compliance Guidance: Provide guidance to practice staff on payer requirements, documentation standards, and billing best practices. Help practices stay ahead of issues rather than reacting to them., • Vendor & Internal Coordination: Coordinate with billing partners, track outstanding items, escalate appropriately, and close the loop with practices. Be the connective tissue between practices and Duet's internal RCM team., • Process Improvement: Flag systemic or recurring issues to RCM leadership. Contribute to building the playbook: developing templates, workflows, and rituals that help us scale RCM operations with consistency and care. What You Bring • 46 years of experience in RCM consulting, billing operations, or a client-facing healthcare revenue role, ideally supporting multiple practices or clients simultaneously., • Deep fluency in the full revenue cycle: charge capture, claim submission, payment posting, denial management, appeals, and A/R resolution., • Ability to quickly diagnose RCM performance issues. You can look at a denial report or aging bucket and know where to start., • Experience advising practice staff or clients on payer requirements, coding accuracy, and documentation standards. Not just flagging problems, but explaining them., • Comfort navigating multiple EMR and practice management platforms (specific systems are trainable; the instinct to figure them out is not)., • Strong written and verbal communication skills. You can translate a complex EOB dispute into a three-sentence email a practice owner actually understands., • Organized and dependable across a full book of practices. Nothing slips, and you don't need to be chased., • Proactive by default: you surface issues before clients ask, and you come with a plan, not just a problem. Who Will Thrive Here • Operational doers who love getting to the bottom of a problem and closing it out clean., • Clear communicators who can translate billing complexity into confident, plain-language updates., • Self-starters who can manage a full portfolio without being handed a checklist every morning., • Folks with a heart for healthcare and a head for process, who take pride in keeping practices financially healthy., • People who bring ownership, humility, and hustle to their work. The salary range for this role is $110,000-$140,000 base salary plus equity. This role is hybrid in NYC.

Job Description Empowerment Academy has four campuses, an Elementary School, Middle School, and two High School sites. 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 High School. We are looking for someone to begin in the 2026/2027 and beyond! Salary: $72,000-$87,000 Hours: 7:15am-3:45pm 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, • Participating in events outside of normal school hours such as family nights, student performances, field trips, and teacher–parent conferences. Requirements • 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., • Self-Starter and someone who takes initiative. Benefits • 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

Job Description The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms. The RN Coordinator will investigate and respond to written and/or verbal clinical appeals, expedited clinical grievances and potential quality of care grievances submitted by members and providers in accordance with Elderplan Contract Benefits, CMS (Centers for Medicare & Medicaid Services), and DOH (Department of Health) regulations. • Graduate of accredited nursing program; BSN preferred, • 2 years managed care or hospital based ulilization/case management experience, • 2 years minimum clinical experience, • Licensed nurse in New York State, • Proficiency with Microsoft Word, Excel, Power Point and Outlook is required, • Must have excellent written ad verbal communication skills, • Must be comfortable researching current evidence based practice guidelines and protocols, • Must be able to multi-task and managed multiple projects efficiently, meet deadlines, demonstrate analytical/critical thinking skills, and provide excellent customer services that leads to positive problem resolution

Job DescriptionDescription: Position Overview: Clinical Case Manager The Clinical Case Manager is responsible for ensuring the increased length of stay, higher levels of reimbursement, medication carve-outs, and authorization coverage throughout patient stays. The Clinical Case Manager reports to the Supervisor of Clinical Case Management. Key Results Area Puts forth best efforts to learn and understand full training provided upon onboarding. Maintain a skilled caseload of 77 patients per day or as established by Senior Leadership, post the 90-day probationary period. Maintains an average length of stay is 22+ for assigned clients. Maintains no more than 10 missing levels post 10 days of admission, with the goal to average 0. Maintains no more than 5 errors across caseload per 30 days on average. Reviews AR logs for accuracy and sends them out to clients on the first business day of the month for the previous month for all assigned clients. Attend all UR meetings per assignment to communicate level requirements and capture the nuances of patient care being provided by clients. Participate in 1:1 meeting with the Supervisor monthly. Remits on the due date, cover page, insurance required form, and complete clinical packet at each NRD to insurance. Follow up with insurance for determination on all NRDs within 72 business hours, to ensure the client does not incur provider liable days. Coordinate/submit all appeal requests to the appeals team, at times submitting appeals to the QIO/ Health plan directly to meet deadlines. Review and obtain carve-outs as outlined in the specified insurance contract or policy. Maintain the Guided Care program with patient details as required and skilled listing, to ensure the accuracy of the current caseload. Respond to client emails and requests by the end of business day. Maintain a high level of customer service and professionalism in all methods of communication. Communicates respectfully with colleagues and leadership. Collaborates with colleagues, helping and handling additional cases during downtime or a lull in individual caseload. Excellent attendance. Other duties as assigned. Evaluate and assess personal performance on a routine basis. Agree to uphold and practice company principles (GUIDE) in all work-related interactions. Requirements: -5+ years of experience in a healthcare environment. -Ideal candidate is a licensed nurse (RN, LPN) or licensed therapist (OT, OTA, PT, PTA, SLP) -Skilled Nursing, LTACH, Hospital experience preferred. -Independent and self-motivated. -Innovative and detail-oriented professional with strong research and organizational skills. -Thrives in a fast-paced, high-pressure environment. • Strong time management with a proven ability to meet deadlines., • Solid collaborative skills with team and clients., • Ability to work remotely and autonomously., • Ability to establish and maintain positive relationships., • Ability to communicate and exchange information and ideas so others will understand., • Demonstrate discretion, sensitivity, and ability to maintain confidentiality., • Quality camera to be used when joining internal and client meetings scheduled via Zoom, Teams, or other video meeting platforms. When participating focus on the matter at hand. Refrains from actively performing other duties even if work-related., • Joins scheduled client meetings timely, best practice 3 minutes before the meeting time, to ensure the best self and company representation., • Microsoft Office proficiency, with the aptitude to learn new programs.

Are you a dedicated hospital nurse looking for a change? Or are you a new grad looking for a rewarding career in personalized care? Take the next step in your professional journey with us and join our team of compassionate Home Health Nurses !. Enjoy a flexible schedule - no night shifts or forced l

The professional registered nurse Outpatient RN CAP 2 may be an entry level designation into the Clinical Advancement Program (CAP) for new employees who meet the RN CAP 2 criteria or attained through advancement from RN CAP 1. Performs all essential functions under the direction of the Supervisor a

Are you a dedicated hospital nurse looking for a change? Or are you a new grad looking for a rewarding career in personalized care? Take the next step in your professional journey with us and join our team of compassionate Home Health Nurses !. Enjoy a flexible schedule - no night shifts or forced l

Registered Nurse (RN) Pediatric Home Health. We are seeking Registered Nurses (RNs) with experience caring for tracheostomy and ventilator-dependent patients in a home health setting. Nurses who thrive here value autonomy, continuity of care, and the ability to deliver skilled nursing in a calm, co

Collaborates with the Medical Director and the Clinical Manager/Charge Nurse regarding the provision of quality patient care in the dialysis facility incorporating all activities from admission through to discharge. Collaborates closely with, providing oversight as needed to, the Clinical Manager/Ch

We are currently seeking Registered Nurses (RNs)to support the Paterson School District. Nurses will be assigned to either a middle school or high school setting and will work 35 hours per week. Registered Nurse (RN) Pediatric Home Health.

Active Registered Nurse (RN) license. Referral bonuses for recommending fellow nurses. Gifted Healthcare is committed to supporting nurses at every stage of their career while helping them make a lasting impact on patient care.

We are currently seeking Registered Nurses (RNs)to support the Paterson School District. Nurses will be assigned to either a middle school or high school setting and will work 35 hours per week. Registered Nurse (RN) Pediatric Home Health.

We are currently seeking Registered Nurses (RNs)to support the Paterson School District. Nurses will be assigned to either a middle school or high school setting and will work 35 hours per week. Registered Nurse (RN) Pediatric Home Health.

Registered Nurse (RN) Pediatric Home Health. We are seeking Registered Nurses (RNs) with experience caring for tracheostomy and ventilator-dependent patients in a home health setting. Nurses who thrive here value autonomy, continuity of care, and the ability to deliver skilled nursing in a calm, co

Healthcare facility is now seeking.Benefits (including Paid time off).Join a fantastic company with opportunity to further your career.Experience an environment with an engaged management team, support and empowerment.We care for our employees so they in turn could care for our residents!.Nursing an

JOB SUMMARY*As an Administrative Assistant IV, you will provide essential administrative support to facilitate the smooth operation of the organization.You will perform a variety of tasks, including managing correspondence, scheduling appointments, organizing meetings, and handling administrative re

Licensed Practical Nurses (LPNs). New Nurse graduates and LPNs with experience are welcome!. Job responsibilities for Licensed Practical Nurses (LPNs) include and are not limited to:.

Healthcare facility is now seeking.Benefits (including Paid time off).Join a fantastic company with opportunity to further your career.Experience an environment with an engaged management team, support and empowerment.We care for our employees so they in turn could care for our residents!.Nursing an

Licensed Practical Nurses (LPNs). New Nurse graduates and LPNs with experience are welcome!. Job responsibilities for Licensed Practical Nurses (LPNs) include and are not limited to:.

JOB SUMMARY*As an Administrative Assistant IV, you will provide essential administrative support to facilitate the smooth operation of the organization.You will perform a variety of tasks, including managing correspondence, scheduling appointments, organizing meetings, and handling administrative re

Administrative Assistant, Studio Operations.The Studios Brooklyn (NSB) Operations team keeps NSB running from the stage floor to the front door.We're a service-oriented team that takes pride in the details: a well-stocked pantry, a smoothly coordinated catering order, a facility maintenance need co

JOB SUMMARY*As an Administrative Assistant IV, you will provide essential administrative support to facilitate the smooth operation of the organization.You will perform a variety of tasks, including managing correspondence, scheduling appointments, organizing meetings, and handling administrative re

The Administrative Assistant III performs a wide variety of tasks such as typing, formatting, and editing correspondence and reports; organizing and correcting computer-based records and files; organizing and preparing materials for use in presentations; scheduling meetings and events; assisting tel

Future Care Consultants Receptionist Position.Future Care Consultants is seeking a bright, motivated, organized, and detail-oriented individual to join our Brooklyn office.We are currently only looking for individuals who can work full-time from 9 AM to 5 PM Monday - Friday and can commit to a minim

Receptionist & Administrative Assistant.Brown Harris Stevens Residential Sales, LLC is the quintessential luxury residential real estate firm, renowned for its leadership and culture of professionalism and discretion since 1873.With offices in New York City, Hudson Valley, The Hamptons, Connecticut,

International investment bank seeks an experienced, self-motivated Assistant to support Fixed Income Sales and Trading business.The ideal candidate is someone able to multi-task, open to learning, and looking to work in a team environment.Responsibilities Provides administrative support for a dynami

Junior Administrative Assistant.Premium Merchant Funding (PMF) is a Wall Streetbased financial services brokerage firm and one of the nation's leading providers of working capital solutions for businesses.Our Wall Street office represents a high-performance, fast-paced, and results-driven environmen

House Manager & Family Assistant (with Administrative Support).Employment Type: Part-time (20 hours/week, with occasional overtime).Schedule: 2 fixed 5-hour mornings or afternoons each week (Monday-Friday), with flexible hours outside of that.Support and communication outside of typical business hou

Answer telephones, relays calls and/or takes messages.Responsible for retrieving and distributing messages left on voice mail off hours to respective staff, in a timely manner.Promote a safe, cooperative and professional health care environment to ensure optimum patient care.Adhere to all hospital p

Client's department of Client Growth and Retention is seeking an Executive Assistant to join the team in the Client home office.This role involves providing administrative support to the department's senior leaders.General responsibilities include arranging meetings, managing calendars, making trave

Administrative Assistant - General.RSC Healthcare is currently seeking General Administrative Assistant for positions in New York, NY.The ideal candidate will possess a current NY license.This is a 8H Days, 07:00:00-15:00:00, 8.Administrative Assistant License and have at least 2 years of recent Gen

Senior Administrative Assistant.Seeking a high-level administrative professional with 10+ years of experience supporting senior management in a fast-paced trading floor environment.The role requires strong organizational skills, discretion, and the ability to manage multiple priorities under pressur

Full Time Administrative Assistant.MHA promotes mental health and total wellness for individuals facing challenges associated with mental illness and addiction recovery.We increase community awareness while enhancing mental well-being through advocacy, education, prevention, treatment, and services.

The Administrative Assistant performs responsible and confidential secretarial and administrative work in support of the Program Director.Under general supervision, this role manages complex clerical tasks requiring independent judgment, discretion, and attention to detail.The Administrative Assista