- Centene Corporation (New York, NY)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... York State clinical license.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals...analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with… more
- Molina Healthcare (Bronx, NY)
- …Medicaid and Medicare.** **We are looking for a LPN or LVN Care Review Clinician with Prior Authorization experience. Experience with Utilization Management (UM) ... is highly preferred. Additional experience with appeals , quality review , MLTC/LTC experience, and experience with data collection/reports.** **_Bilingual… more