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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 Requirements As Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize clinical expertise and reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will provide an interpretation of the medical necessity of services provided by other healthcare professionals in compliance with client specific policies, nationally recognized evidence-based guidelines, and standards of care. MAJOR DUTIES AND RESPONSIBILITIES: • Reviews all medical records and addresses each question posed by the client utilizing client specific criteria or other nationally recognized evidence-based criteria, • Ensures that the rationale for the determination is clear, concise, and contains adequate supporting documentation to substantiate the decision, • Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature that support sound and objective decision-making and rationales in reviews; refrains from using case studies, cohorts, and the like to make decisions due to their limited sample sizes, • Provides copies of any criteria utilized in a review with the report in a timely manner, • Returns cases on or before the due date and time, • Makes telephone calls as mandated by the state and/or client specifics, • Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job, • Attends all required orientation and training, • Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits, • Board certification required, active practice required PLEASE BE AWARE: In the interest of the security of all parties, Dane Street will never conduct interviews via text or request checks from candidates for any reason including the purchase of equipment. Benefits • Robust opportunity for supplemental income, • Schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct exams and reviews based on your schedule availability, • No doctor/patient relationship is established and no treatment is provided. These are advisory-only opinions., • Enhanced industry expertise strengthening your medical practice with medical necessity and utilization review/management expertise, • Expanded credentials as an expert in Independent Medical Exams and physician advisor services, • Fully prepped cases, streamlined case flow, transcription services at no cost, and user-friendly work portal Dane Street supports all referral processes, scheduling, preps cases extensively, prepares all medical records, provides transcription services as applicable, facilitates all client communications, and ensures the quality and timeliness of all reports and report delivery. Apply for this job

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.

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

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’re seeking talented healthcare professionals whose adventure game is as strong as their clinical game.

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’re seeking talented healthcare professionals whose adventure game is as strong as their clinical game.

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

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.

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

Access to our Clinical Nurse Liaison Team.

DocCafe has an immediate opening for the following position: Nurse Practitioner - Family Practice/Primary Care 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 o

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

DocCafe has an immediate opening for the following position: Nurse Practitioner - Family Practice/Primary Care in New York.Make $100,000 - $120,000/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

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.

Prime Staffing is seeking a travel nurse RN Labor and Delivery for a travel nursing job in West Islip, New York.Job Description & Requirements.Registered Nurse – Labor & Delivery (L&D).Minimum 2 years of recent L&D experience required.Active State or Compact RN License.BLS, ACLS, NRP required –

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.

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

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

Nightingale Nurses is seeking a travel nurse RN Labor and Delivery for a travel nursing job in West Islip, New York.Job Description & Requirements Specialty: Labor and Delivery Discipline: RN Start Date: 09/22/2025 Duration: 13 weeks 36 hours per week Shift: 12 hours, days Employment Type: Travel Ab

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.

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

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

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.

Provides clinical supervision for entry level nurses and assists in their development. Responsibilities: Sing clinical reasoning Developing, implementing and evaluating the nursing plan of care Managing both emotional and physical patients Assessing patient and family level of understanding to provi

Care Team Solutions is seeking a travel nurse RN Labor and Delivery for a travel nursing job in West Islip, New York.Job Description & Requirements.Registered Nurse must have 2+ years of recent experience in particular specialty.Must Have 2+ Years of recent Labor and Delivery experience.Six things t

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.

GHR Healthcare is seeking a travel nurse RN Labor and Delivery for a travel nursing job in West Islip, New York.Job Description & Requirements Specialty: Labor and Delivery Discipline: RN Start Date: 09/22/2025 Duration: 13 weeks 36 hours per week Shift: 12 hours Employment Type: Travel GHR Healthca

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.

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

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

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

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

Army Social Workers use their skills to enhance unit readiness and the well-being of Soldiers and their families If you are a practicing professional as a social worker and want to combine your specialized skills with the desire to serve your Nation's heroes, a career as an Army Social Worker might

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

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.

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

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

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.

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

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

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. Reports changes in patient status regarding any clinical, insurance, or travel and transportation issues. Provides support for all clinica

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

Army Social Workers use their skills to enhance unit readiness and the well-being of Soldiers and their families If you are a practicing professional as a social worker and want to combine your specialized skills with the desire to serve your Nation's heroes, a career as an Army Social Worker might