Greenlife Healthcare StaffingNewRN Clinical Reviewer Greenlife Healthcare StaffingRN Clinical ReviewerJericho, NYThis individual will work under the direction of the supervisor of the team performing clinical reviews and abstractions of assigned cases related to a maternal death or to an adverse event that occurred during an outpatient surgical procedure. Impactful Work: Contribute to a mission-driven organization dedicated to improving patient outcomes by identifying and analyzing critical events in maternal care and outpatient surgical procedures.
Greenlife Healthcare StaffingNewRegistered Nurse Clinical Reviewer / IDR Greenlife Healthcare StaffingRegistered Nurse Clinical Reviewer / IDRJericho, NYThis includes chart screens, compiling regulatory guidance, researching insurer requirements, completing electronic worksheets, and preparing final determinations. We are currently seeking a Registered Nurse Clinical Reviewer / IDR to fill an opening with a Non-profit organization located in Jericho, New York.
GreenLife Healthcare StaffingRN Clinical Reviewer GreenLife Healthcare StaffingRN Clinical ReviewerJericho, NYThis individual will work under the direction of the supervisor of the team performing clinical reviews and abstractions of assigned cases related to a maternal death or to an adverse event that occurred during an outpatient surgical procedure. Impactful Work: Contribute to a mission-driven organization dedicated to improving patient outcomes by identifying and analyzing critical events in maternal care and outpatient surgical procedures.
GreenLife Healthcare StaffingRN Clinical Reviewer (Proofer) GreenLife Healthcare StaffingRN Clinical Reviewer (Proofer)Jericho, NYGreenlife Healthcare Staffing is seeking a meticulous Clinical Reviewer Proofer Registered Nursewho will complete the full spectrum of activities related to Utilization or Quality reviews as assigned. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals.
GreenLife Healthcare StaffingRegistered Nurse Clinical Reviewer / IDR GreenLife Healthcare StaffingRegistered Nurse Clinical Reviewer / IDRJericho, NYGreenlife Healthcare Staffing is currently seeking a Registered Nurse Clinical Reviewer / IDR to fill an opening with a Non-profit organization located in Jericho, New York. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals.
GreenLife Healthcare StaffingNewRegistered Nurse Clinical Reviewer GreenLife Healthcare StaffingRegistered Nurse Clinical ReviewerJericho, NYGreenlife Healthcare Staffing is currently seeking a Registered Nurse Clinical Reviewer / IDR to fill an opening with a Non-profit organization located in Jericho, New York. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals.
Greenlife Healthcare StaffingRegistered Nurse Clinical Reviewer / AIMS Greenlife Healthcare StaffingRegistered Nurse Clinical Reviewer / AIMSBronx, New YorkRemote$50About Greenlife Healthcare Staffing:We are committed to our core values: integrity, honesty, and transparencyFinding a new position as a physician or allied health professional or filling a critical vacancy in your practice, clinic, hospital, or skilled care facility can be stressful and time-consuming. We understand that every situation is different and our approach reflects that: we value personalized interaction with job seekers and employers, our searches are customized not cookie-cutter and our results speak for themselves: Happy job seekers and employers who found the right professional match through our services.
Greenlife Healthcare StaffingRN Clinical Reviewer (Proofer) Greenlife Healthcare StaffingRN Clinical Reviewer (Proofer)Jericho, New York$45About Greenlife Healthcare Staffing:We are committed to our core values: integrity, honesty, and transparencyFinding a new position as a physician or allied health professional or filling a critical vacancy in your practice, clinic, hospital, or skilled care facility can be stressful and time-consuming. We understand that every situation is different and our approach reflects that: we value personalized interaction with job seekers and employers, our searches are customized not cookie-cutter and our results speak for themselves: Happy job seekers and employers who found the right professional match through our services.
Greenlife Healthcare StaffingRegistered Nurse Clinical Reviewer Greenlife Healthcare StaffingRegistered Nurse Clinical ReviewerJericho, New York$60About Greenlife Healthcare Staffing:We are committed to our core values: integrity, honesty, and transparencyFinding a new position as a physician or allied health professional or filling a critical vacancy in your practice, clinic, hospital, or skilled care facility can be stressful and time-consuming. We understand that every situation is different and our approach reflects that: we value personalized interaction with job seekers and employers, our searches are customized not cookie-cutter and our results speak for themselves: Happy job seekers and employers who found the right professional match through our services.
Greenlife Healthcare StaffingRN Clinical Reviewer / IDR Greenlife Healthcare StaffingRN Clinical Reviewer / IDRJericho, NYRemote$100,000–$105,000Greenlife Healthcare Staffing is seeking an experienced Registered Nurse Clinical Reviewer (IDR) to join a remote position at a Non-profit organization located in New York. Soft Skills: Excellent written/verbal communication; ability to work independently; flexible and innovative; meets deadlines in sensitive environments; strong collaborative and problem-solving skills.
Acentra HealthClinical Reviewer Behavioral Health Acentra HealthClinical Reviewer Behavioral HealthNYRemote$28.37–$39.19 / hourRequired qualifications: Active and unrestricted license for the State of Virginia as a Registered Nurse (RN) OR Licensed Mental Health Professional (LMHP) such as Licensed Clinical Psychologist (LCP), Licensed Professional Counselor (LPC), Licensed Clinical Social Worker (LCSW), Licensed Substance Abuse Treatment Practitioner (LSATP), Licensed Marriage and Family Therapist (LMFT). For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education.
CVS Health CorpPrior Authorization Clinical Reviewer CVS Health CorpPrior Authorization Clinical ReviewerNY$26.01–$74.78 / yearApplication of critical thinking and knowledge of clinically appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services for members with disabilities and special healthcare needs. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
New Wave PeopleNewRegistered Nurse - Reviewer New Wave PeopleRegistered Nurse - ReviewerSyracuse, NY$40–$47 / hourAdditional responsibilities will include, but are not limited to: review complaint intakes, investigation of complaints, review of facility generated incident reports, report development using applicable computer programs, review of Plans of Correction, review of applications for new licensed and certified programs, review of facility Policies and Procedures, preparation of general correspondence, participation in meetings and on committees, and participation in Enforcement Action against ACFs including testifying at hearings. Preferred Qualifications: The ideal Candidate will have professional skills including nursing surveillance, clinical skills, excellent writing and editing skills, and proficiency navigating computer applications used for surveillance or utilization review, SharePoint, and the Electronic Plan of Correction system, and has the ability to expeditiously and effectively interpret laws and regulations governing adult care and assisted living facilities in New York State.
VNS HealthQuality Reviewer/Auditor, Registered Nurse (Remote) VNS HealthQuality Reviewer/Auditor, Registered Nurse (Remote)New York, New YorkRemote$93,400–$116,800 / yearEnsures Quality Improvement programs are aligned with CMS Triple Aim framework: improving the patient’s experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of healthcare. This is an opportunity to apply your clinical expertise beyond bedside care, leveraging your knowledge to influence system-wide improvements, enhance compliance, and protect member safety at scale, while benefiting from the flexibility of a hybrid role.
HealthfirstMedical Peer Reviewer HealthfirstMedical Peer ReviewerNew York City, NY$122,907–$188,020 / yearIf you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . A vital role of the CMO Administration team, the Medical Peer Reviewer plays a critical role in consulting on medical necessity in the context of utilization management and ensuring adherence to internal Healthfirst and external regulations.
HealthCare Partners, MSOMedical Director - UM Reviewer HealthCare Partners, MSOMedical Director - UM ReviewerGarden City, NY$260,000–$285,000 / yearCollaborate with Provider Networks, Quality and Medical Management teams in creating and maintaining programs that incentivize providers to achieve selected utilization/cost and quality outcomes. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products.
Catholic HealthCDI Second Level Reviewer Catholic HealthCDI Second Level ReviewerMelville, New York$145,000–$180,000 / yearThis role focuses on identifying documentation opportunities in complex or high-risk cases to ensure accurate representation of patient acuity, quality outcomes (such as expected mortality), and financial performance. Job Details: The CDI Second Level Reviewer is an experienced Clinical Documentation Specialist responsible for performing advanced, targeted case reviews on potentially high-impact encounters.
MedReviewDRG (Coding) Reviewer/Auditor MedReviewDRG (Coding) Reviewer/Auditornew york, NYFull timeResponsibilities:Analyze and review inpatient claims following the Official Coding and Reporting Guidelines to validate the reported ICD-10-CM/PCS codes to ensure proper DRG assignment for accurate billing. Under the direction of the DRG Operations Department leaders, the DRG Reviewer will conduct reviews of inpatient claims for both coding accuracy as well as perform screening referrals for clinical support of coded diagnoses.
ISLAND PEER REVIEW ORGANIZATION, INC.Coding Reviewer ISLAND PEER REVIEW ORGANIZATION, INC.Coding Reviewergreat neck, NY$65,000–$70,000 / yearEducation & 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.•
Trinity HealthRN Clinical Documentation Specialist - ST Peters Hospital Trinity HealthRN Clinical Documentation Specialist - ST Peters HospitalAlbany, NY$31.50–$47.97 / yearPeters Hospital in Albany, NY Position Highlights: - Recognized leader: Magnet Hospital in the Capital Region - Quality of Life: Where career opportunities and quality of life converge - Advancement: Strong orientation program, generous tuition allowance and career development What you will do: The Clinical Documentation Specialist utilizes advanced clinical and coding expertise to direct efforts toward the integrity of clinical documentation through the roles of reviewer, educator and consultant. - Must possess one of the below: - Current Registered Nurse License - Registered Health Information Administrator (RHIA) - Registered Health Information Technician (RHIT) - Certified Coding Specialist (CCS) required - Licensure as a physician assistant (PA) or Nurse Practitioner/Advanced Practice Nurse (NP/APN) or completion of medical school.
VNS HealthG&A Specialist, Clinical RN (Per Diem) VNS HealthG&A Specialist, Clinical RN (Per Diem)New York, New YorkRemote$49.55–$61.96 / hourMinimum three years progressive professional experience in health care, including a minimum of two years in a grievance and appeals or related area such as medical or utilization management requiredProficient verbal/written communication skills requiredProficient computer and typing skills and knowledge of Microsoft Office (Word and Excel) requiredAbility to work in a fast paced environment and effectively manage multiple grievances and appeals simultaneously. What You Will DoDevelops and maintains current knowledge of state and federal regulatory requirements related to all aspects of grievances and appeals for Medicare managed care organizations, Medicaid, home health care, managed long term care as well as contractual requirements.
Northwell HealthRegistered Nurse (RN) - Clinical Care Coordinator (PER DIEM) Northwell HealthRegistered Nurse (RN) - Clinical Care Coordinator (PER DIEM)Bay Shore, NYArranges for patients post hospital needs, i.e. visiting nurse, physical therapy, medical/social model day care, personal care aides, Long Term Home Health Care Programs, home health aides, private hire, DME (equipment, supplies, and respiratory needs). + * Makes arrangement for non-North Shore-Long Island Jewish Home Care services including home care, Hospice, equipment, supplies and laboratory services for post discharge needs.
Heartbeat Health IncClinical Research Writer Heartbeat Health IncClinical Research WriterNY$90,000–$130,000 / yearPreferred: Experience with large healthcare datasets (EHR, claims, monitoring data) Knowledge of IRB processes and regulatory requirements Experience with digital health, virtual care, or outcomes research Prior authorship in CV journals or presentations at major cardiology conferences (ACC, AHA, HRS, ESC). Required: Advanced degree (MD, PhD, MPH, MS, or equivalent) Experience conducting clinical research or real-world evidence studies Strong statistical and data analysis skills Demonstrated experience writing and publishing peer-reviewed manuscripts Familiarity with cardiovascular clinical research preferred.
Capgemini SESenior Consultant - Life Sciences, Clinical Data & Applications (R&D) Capgemini SESenior Consultant - Life Sciences, Clinical Data & Applications (R&D)New York, NY$112,600–$160,000 / yearIt delivers end-to-end services and solutions leveraging strengths from strategy and design to engineering, all fueled by its market leading capabilities in AI, generative AI, cloud and data, combined with its deep industry expertise and partner ecosystem. Leaders in digital transformation, the team has helped clients establish innovation incubators, develop digital medicine strategies, enhance patient experiences, and identify new revenue sources.
Spring HealthBusiness Analyst, Operations Performance (Clinical Operations) Spring HealthBusiness Analyst, Operations Performance (Clinical Operations)New York City, NYRemote$80,000–$92,000 / yearThis role is part of the Operations Performance team - within the broader Operations Intelligence function - and will own core quality measurement, insights, and improvement loops that enable Clinical Operations to deliver consistently excellent member experiences at scale. Develop and maintain scalable quality monitoring frameworks for the Clinical Ops department, including sampling strategies, QA rubrics, and calibration processes to ensure scoring consistency across reviewers and teams.
College BoardClinical Manager SSD College BoardClinical Manager SSDNew York, NYRemote$64,000–$110,000 / yearOur robust benefits package includes health, dental, and vision insurance, generous paid time off, paid parental leave, fertility benefits, pet insurance, tuition assistance, retirement benefits, and more Recognition of exceptional performance through annual bonuses, salary growth over time through market increases, and opportunities for merit raises and promotions based on increased scope of responsibility A job that matters, a team that cares, and a place to learn, innovate and thrive You can expect to have transparent conversations about benefits and compensation with our recruiters throughout your application process. Additionally, the Clinical Manager communicates with school personnel, test-takers, families/guardians, and other College Board departments regarding documentation and accommodations, and serves as a resource in understanding psycho-educational assessment.
Catholic HealthUtilization Management Director Catholic HealthUtilization Management DirectorMelville, New York$150,000–$215,000 / yearIn addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth. Ability to effectively communicate with all levels of hospital staff in a verbal and written manner; demonstrated ability to be organized and efficient in prioritizing and managing assignments with minimal oversight and direction.
Rose InternationalAdministrative Assistant Jobs in USA, NY, Albany | Rose International Job Rose InternationalAdministrative Assistant Jobs in USA, NY, Albany | Rose International JobAlbany, NY$23–$23 / hourTemporaryRose International has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). California Pay Equity: For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website here.
ExlService Holdings IncMedical Director - Payment Integrity Services ExlService Holdings IncMedical Director - Payment Integrity ServicesNY$215,000–$290,000 / yearYour background in managed care, utilization management, and ideally payment integrity equips you to assess medical necessity, level of care, and documentation with confidence, while your ability to interpret data, communicate clearly, and work in a matrixed environment helps you drive meaningful improvements in payment decisions at scale. You help design and refine pre‑pay and post‑pay review workflows, clinical audits, coding integrity initiatives, and fraud, waste, and abuse reviews, while reviewing complex cases and supporting criteria and policy development so that our determinations are clinically sound, defensible, and practical.
Clover Health Investments CorpMedical Director, Utilization Management Clover Health Investments CorpMedical Director, Utilization ManagementNYRemote$280,000–$310,000 / yearAdditional Perks: Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities Reimbursement for office setup expenses Monthly cell phone & internet stipend Remote-first culture, enabling collaboration with global teams Paid parental leave for all new parents. The physician will utilize Local and National Medicare Coverage Determinations, Milliman Care Criteria, Clover Health's medical policies reviews to determine medical necessity or if an alternate treatment plan is required for our members.
Cohere Health Technologies LLCAssociate Medical Director, Orthopedic Surgery Cohere Health Technologies LLCAssociate Medical Director, Orthopedic SurgeryNYRemote$250,000–$265,000 / yearBacked by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners, Cohere Health drives more transparent, streamlined healthcare processes, helping patients receive faster, more appropriate care and higher-quality outcomes. By unifying pre-service authorization data with post-service claims validation, we're creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately.
Metropolitan Jewish Health SystemSupervisor, Concurrent Review RN Metropolitan Jewish Health SystemSupervisor, Concurrent Review RNNew York, New YorkSupervises the assessment and coordination of the members physical, psychosocial and discharge planning needs through communication with appropriate hospital staff including treating physician, PCP, utilization managers, social workers, discharge planners. The MJHS Difference: At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services.
Catholic HealthCDI Educator Catholic HealthCDI EducatorMelville, New York$115,000–$165,000 / yearAssess ongoing CDI team educational needs using data, audits, trends, denials, and performance metricsCollaborate with CDI Second Level Reviewers to provide education to the concurrent review team on opportunities identified through second level reviews. This role supports both ongoing staff development and structured onboarding of new CDI team members, using data, trends, and industry updates to drive education that improves documentation accuracy, quality outcomes (such as expected mortality), and program consistency.
GuideWell Mutual Holding CorpMedical Director Care Management GuideWell Mutual Holding CorpMedical Director Care ManagementNY$224,000–$364,000 / yearKey Responsibilities: • Perform all types of utilization management (UM) reviews, including but not limited to Pre-service, Post-service, Concurrent Review and Appeals • Discuss cases with physician providers (Peer to Peer) • Apply health plan review hierarchy to member contracts, medical policy, clinical guidelines and other approved resources to render timely decisions on medical necessity requests • Collaborate with Case Managers to provide support and guidance on cases needing physician assistance • Meet any established metrics (compliance and accreditation) related to UM review efficiency, timeliness, and quality of review • Participate in ongoing Inter-rater reliability (IRR) audits and any other health plan audits as necessary • As necessary, assist nurses and other staff in understanding the principles behind appropriate utilization review and interpretation and application of benefits and policies • Participate in the development and review of Medical and Pharmacy policies as assigned • Support the organization as a subject matter expert • Perform as lead Medical Director consultant for one sub-category of utilization management, such as commercial or Medicare medical policy • Perform other duties as assigned and needed by the organization. Position Requirements: • Current unrestricted Florida medical license as a Doctor of Medicine or Doctor of Osteopathic Medicine • Board Certification or Board eligibility by American Board of Medical Specialties or equivalent • 5+ years of clinical experience • Experience working in a dynamic, fast-paced environment • Experience working both independently and in a team environment • Exceptional verbal and written communication.
Clarkson UniversityAdministrative Coordinator INTERNAL ONLY Clarkson UniversityAdministrative Coordinator INTERNAL ONLYPotsdam, NY$19.78–$22.18 / hourGeneral Purpose The Administrative Coordinator is responsible for providing a wide variety of clerical, secretarial and receptionist support for the department, department team members and the students associated with the department. Primary Areas of Responsibility Primary areas of responsibility for this position include: • Collaboration with graduate student admissions, recruiting, and support; • New staff and student orientation and all phases of office administration.
Clarkson UniversityAdministrative Coordinator- INTERNAL ONLY Clarkson UniversityAdministrative Coordinator- INTERNAL ONLYPotsdam, New York$19.78–$22.18 / hourGeneral Purpose: The Administrative Coordinator is responsible for providing a wide variety of clerical, secretarial and receptionist support for the department, department team members and the students associated with the department. • Send required admissions status updates including missing-document notices, decision notifications, deposit confirmations, and intent -to-matriculate communications.