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About The Role Brighton Health Plan Solutions (BHPS) provides Utilization Review/Medical and Case Management services for Group Health and Workers’ Compensation and other Casualty clients. The Workers’ Compensation Nurse Case Reviewer collaborates with medical care providers, employers, employees, and at times, attorneys to support the appropriate return to work, the provision of necessary medical services, and the evaluation of coverage under the Plan. The Nurse Case Manager reports to the Casualty Department Manager. Primary Responsibilities • Collaborates with workers' compensation patients, employers, providers, and claims adjusters to coordinate medical and disability services for timely return to work, • Provides case management, utilization review, continued stay reviews, and based on clinical judgment and state WCB Medical Treatment Guidelines, • Knowledgeable and compliant with New York State Workers’ Compensation Law, Medical Treatment Guidelines, ERISA, HIPAA confidentiality requirements, and NY Formulary Review process, • Proven ability to anticipate claimant's treatment or recovery milestones, • Provides Case Management services, including assessing barriers to recovery and determining treatment alternatives, • Facilitates and expedites discharge planning as needed, • Produces accurate electronic records of individual cases, • Ensures timely, cost-effective medical care for injured workers' recovery, • Answers provider calls and assists with Casualty Department workload as necessary, • Kind, caring, and positive with all customers and fellow employees, • Adheres to established quality assurance standards and MagnaCare policies and procedures Essential Qualifications • Currently licensed Registered Nurse in the state of NY, or the ability to obtain, • Maintain current licensure(s) and specialty certifications that are relevant to this position; CCM is encouraged, • Minimum 1 year experience in worker’s compensation case management, • Bachelor’s degree preferred, • Minimum of 4 years’ experience in a clinical environment required, • Strong skills in medical assessment/medical record review, • Excellent customer service skills, • Ability to define and solve problems, collect data, establish facts and make effective decisions a must., • Must be detail oriented and have strong organizational and time management skills, and the ability to work independently., • Ability to work proficiently on a computer (PC) with working knowledge of Microsoft Office, especially Word, Excel Teams, and Outlook Powered by JazzHR zEGYw9cEHB

Job Description As a Clinical Reviewer you will complete the full spectrum of activities related to State Independent Review Organization (IRO) case determinations. You will conduct clinical level review, determine physician level assignment, manage case staging between external physician experts and manage appeal processes within strict deadlines. Duties include but are not limited to: • Conducting reviews up to and including the appeal level. This includes chart screening, writing case summaries, determining documentation adequacy, researching insurer requirements, complete decision templates and preparing final determinations., • Act as a resource for the administrative and clinical staff in training, problem solving, and clarifying determinations., • Training and mentoring new RNs as the project expands., • Understanding multi-state requirements. QUALIFICATIONS: • Knowledge and experience with electronic medical records., • Ability to oversee, problem solve and work collaboratively with peers, medical, analytical, and administrative support staff., • Excellent written and verbal skills., • Ability to work independently with little supervision., • Ability and desire to be flexible, innovative, and creative., • New York Licensed Registered Nurse, required., • A bachelor’s degree in nursing OR graduate of an approved Registered Professional Nurses training program, required. The salary range and/or hourly rate listed does not include other forms of compensation or benefits. IPRO is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, protected veteran status or military status.

Job DescriptionAbout The Role Brighton Health Plan Solutions (BHPS) provides Utilization Review/Medical and Case Management services for Group Health and Workers’ Compensation and other Casualty clients. The Workers’ Compensation Nurse Case Reviewer collaborates with medical care providers, employers, employees, and at times, attorneys to support the appropriate return to work, the provision of necessary medical services, and the evaluation of coverage under the Plan. The Nurse Case Manager reports to the Casualty Department Manager. Primary Responsibilities • Collaborates with workers' compensation patients, employers, providers, and claims adjusters to coordinate medical and disability services for timely return to work., • Provides case management, utilization review, continued stay reviews, and based on clinical judgment and state WCB Medical Treatment Guidelines., • Knowledgeable and compliant with New York State Workers’ Compensation Law, Medical Treatment Guidelines, ERISA, HIPAA confidentiality requirements, and NY Formulary Review process., • Proven ability to anticipate claimant's treatment or recovery milestones., • Provides Case Management services, including assessing barriers to recovery and determining treatment alternatives., • Facilitates and expedites discharge planning as needed., • Produces accurate electronic records of individual cases., • Ensures timely, cost-effective medical care for injured workers' recovery., • Answers provider calls and assists with Casualty Department workload as necessary., • Kind, caring, and positive with all customers and fellow employees., • Adheres to established quality assurance standards and MagnaCare policies and procedures.Essential Qualifications, • Currently licensed Registered Nurse in the state of NY, or the ability to obtain., • Maintain current licensure(s) and specialty certifications that are relevant to this position; CCM is encouraged., • Minimum 1 year experience in worker’s compensation case management., • Bachelor’s degree preferred., • Minimum of 4 years’ experience in a clinical environment required., • Strong skills in medical assessment/medical record review., • Excellent customer service skills., • Ability to define and solve problems, collect data, establish facts and make effective decisions a must., • Must be detail oriented and have strong organizational and time management skills, and the ability to work independently., • Ability to work proficiently on a computer (PC) with working knowledge of Microsoft Office, especially Word, Excel Teams, and Outlook. Powered by JazzHR zEGYw9cEHB

Job Description As a Coding Reviewer, you will be responsible for the general coding validation and verification and preparation of independent dispute resolution reviews from external state and federal agencies in accordance with reporting requirements. Duties include but are not limited to: • Confirm and verify submitted codes for DRG validation., • Apply national coding standards and regulations to the claims and clinical data., • Provide subject matter input and support agency-wide projects., • Other duties as assigned. This position requires working on-site at the Jericho, NY office. Qualifications: • Excellent interpersonal and communication skills, both written and verbal., • Ability to relate effectively with technical, medical, analytical and administrative personnel., • Proficiency in EHR applications, office technology, and Microsoft applications including Word, Excel, and PowerPoint., • Being able to handle sensitive and confidential information., • Ability to work in a team environment and independently. Education & Experience: • Licensed Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Coding Specialist (CCS)/ Certified Coding Specialist Physician (CCS-P) required., • Technical knowledge of coding and DRG validation with CPT, HCPCS experience and ICD-10 certification required, • Bachelor’s degree in healthcare administration or health information management preferred., • Minimum of two (2) years of experience abstracting and coding of outpatient medical records for billing., • Some experience in utilization reviews preferred. The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. The annualized salary range for this position is $65,000.00 – $70,000.00. Actual salary range and/or hourly rate depends on a variety of factors including experience, education, credentials, location, and budget. The salary range listed does not include other forms of compensation or benefits. IPRO is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or military status.

Adheres to all requirements of the FMCNA Compliance Program, and FMS patient care and administrative policies as the clinical leader, has the authority to make daily decisions to ensure continuity of care and patient and staff safety. Ensures all FMS Clinical Quality policies and procedures are comm

Are you a CRNA searching for your next exciting locum tenens opportunity? This position with one of VISTA's healthcare partners in New York might just be the opportunity for you!.Schedule: Monday‐Friday, 8 hour days, No call.Type of Cases: Bread and Butter, OB, Ortho.Credentialing: 60&dash

As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning for our managers. As a Clinical Manager, you may

Nurse Practitioner (NP) or Physician Assistant (PA) – Veteran Disability Assessments.Nurse Practitioner (NP) or Physician Assistant (PA).VA's disability benefits process.This role involves conducting .Review and analyze electronic medical records via a secure web portal.Accurately document exam f

Manages patient care in home therapies programs while maintaining cost-effective clinical operations. Directs activities related to the Continuous Quality Assurance Improvement, patient retention and Clinical Algorithm Adoption, patient access management and patient training success.

Nurse Practitioner (NP) or Physician Assistant (PA) – Veteran Disability Assessments.Nurse Practitioner (NP) or Physician Assistant (PA).VA's disability benefits process.Review and analyze electronic medical records via a secure web portal.Accurately document exam findings and complete the require

At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives.

Nurse Practitioner (NP) or Physician Assistant (PA) – Veteran Disability Assessments.Nurse Practitioner (NP) or Physician Assistant (PA).VA's disability benefits process.Review and analyze electronic medical records via a secure web portal.Accurately document exam findings and complete the require

We offer competitive pay, comprehensive benefits, and access to diverse clinical experiences that build your skills and open doors to new possibilities. Whether you want to explore new locations, broaden your clinical experience, or achieve better work–life balance, Olaro provides the flexibility

Nurse Practitioner (NP) or Physician Assistant (PA) – Veteran Disability Assessments.Nurse Practitioner (NP) or Physician Assistant (PA).VA's disability benefits process.Review and analyze electronic medical records via a secure web portal.Accurately document exam findings and complete the require

Care Team Solutions is seeking a travel nurse RN Interventional Radiology for a travel nursing job in Roslyn, New York.Job Description & Requirements.Registered Nurse must have 2+ years of recent experience in particular specialty.Must Have 2+ Years of recent Interventional Radiology experience.Six

Genie Healthcare is seeking a travel nurse RN Med Surg for a travel nursing job in Utica, New York.Job Description & Requirements Specialty: Med Surg Discipline: RN Start Date: 10/13/2025 Duration: 13 weeks 36 hours per week Shift: 12 hours, nights Employment Type: Travel Genie Healthcare is looking

DocCafe has an immediate opening for the following position: Nurse Practitioner - Family Practice/Primary Care in New York.Make $120,000 - $130,000/yearly.DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career.Register now to apply for this job an

Core Medical Group is seeking a travel nurse RN Maternal - Newborn for a travel nursing job in Niskayuna, New York.Job Description & Requirements Specialty: Maternal - Newborn Discipline: RN Start Date: 10/06/2025 Duration: 13 weeks 36 hours per week Shift: 12 hours Employment Type: Travel Client in

Planet Healthcare is a global leader in clinical staffing because we take a candidate-first approach.

DocCafe has an immediate opening for the following position: Nurse Practitioner - Telehealth in New York.DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career.Register now to apply for this job and for access to 120,000+ other openings.DocCafe Of

This role requires clinical judgment, close monitoring, and management of complex patient conditions.

Posted job title: RN:PCU - Progressive Care Unit,07:00:00-19:00:00 About Voca Healthcare As a Voca Traveler, you will gain new clinical skills, visit amazing places and meet awesome healthcare professionals.

At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives.

Posted job title: RN:PCU - Progressive Care Unit,19:00:00-07:00:00 About Voca Healthcare As a Voca Traveler, you will gain new clinical skills, visit amazing places and meet awesome healthcare professionals.

At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives.

Openwork Health is seeking a travel nurse RN Med Surg for a travel nursing job in Utica, New York.Job Description & Requirements Specialty: Med Surg Discipline: RN Start Date: 10/20/2025 Duration: 12 weeks 36 hours per week Shift: 12 hours, nights Employment Type: Travel Openwork Health Job ID 72652

GHR Healthcare is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Utica, New York.Job Description & Requirements Specialty: ED - Emergency Department Discipline: RN Start Date: 10/13/2025 Duration: 12 weeks 36 hours per week Shift: 12 hours Employment Type: Travel GHR

At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives.

Posted job title: RN:Med Surg,19:00:00-07:00:00 About Voca Healthcare As a Voca Traveler, you will gain new clinical skills, visit amazing places and meet awesome healthcare professionals.

Network Adjusters is seeking a friendly, organized, and proactive individual to join our customer service team in our New York office in Farmingdale.The ideal candidate has excellent communication and customer service skills.He/she has an excellent understanding of administrative and clerical proced

Assist with clinical and operational processes to improve patient health and minimize hospitalizations and missed treatments. Must have basic computer skills; proficiency in all USRC clinical applications required within 90 days of hire.

The New York State Unified Court System is seeking a.Genesee County Problem-Solving Courts.This position will assist with expanding and managing the requirements and resources of the court’s BRIDGE program and provide a supportive role in the implementation of problem-solving courts.Provide case m

How you'll change lives As a Registered Nurse (RN) at US Renal Care, you'll be an integral part of a cross-functional team, working under the supervision of a Charge Nurse and assisting and supervising Patient Care Technicians (PCTs) to care for patients living with kidney disease.What you'll be doi

DocCafe has an immediate opening for the following position: Nurse Practitioner - Endocrinology in New Hyde Park, New York.DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career.Register now to apply for this job and for access to 120,000+ other o

Network Adjusters is seeking a friendly, organized, and proactive individual to join our customer service team in our New York office in Farmingdale.The ideal candidate has excellent communication and customer service skills.He/she has an excellent understanding of administrative and clerical proced

Care Team Solutions is seeking a travel nurse RN Interventional Radiology for a travel nursing job in Roslyn, New York.Job Description & Requirements.Registered Nurse must have 2+ years of recent experience in particular specialty.Must Have 2+ Years of recent Interventional Radiology experience.

About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. Provides support for all clinical staff members at regular intervals and encourages professional growth. Training and advancement: You wil

Core Medical Group is seeking a travel nurse RN Maternal - Newborn for a travel nursing job in Niskayuna, New York.Job Description & Requirements.Client in NY seeking Registered Nurse: Mother/Child.We are looking for a healthcare professional who is ready to provide exceptional patient care in t

SIGN ON BONUS AVAILABLE PURPOSE AND SCOPE: Manages patient care in home therapies programs while maintaining cost-effective clinical operations. Directs activities related to the Continuous Quality Assurance Improvement, patient retention and Clinical Algorithm Adoption, patient access management an

Planet Healthcare is a global leader in clinical staffing because we take a candidate-first approach.

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Adheres to all requirements of the FMCNA Compliance Program, and FMS patient care and administrative policies as the clinical leader, has the authority to make daily decisions to ensure continuity of care and patient and staff safety PRINCIPAL DUTIES AND RESPONSIBILITIES: Manages the tactical execut

We're on the hunt for curious, motivated individuals to test and review online money-making opportunities featured on FinanceBuzz.If you enjoy discovering new platforms and sharing your experience, this flexible gig could be perfect for you.Qualifications, skills, and all relevant experience needed

About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. Training and advancement: You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning for ou

Far Rockaway Center is hiring a Registered Nurse (RN) Supervisor for the.Complete resident care requirements by scheduling and assigning nursing staff.Establish a compassionate environment by providing support to residents & families.Provide information to residents & staff by answering questions an

About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. Training and advancement: You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning for ou

Looking for extra income but not sure where to start? We’re hiring people to explore and review online side hustles listed by FinanceBuzz.No experience needed – just a willingness to try out different platforms and report your findings.Not sure what skills you will need for this opportunity Simp

Provides counseling for all clinical staff members at regular intervals offering support and encouraging professional growth. Minimum of 12 months experience in clinical nursing is required. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance w