Clinical Coordinator Remote Jobs in New York (US)

This page tracks remote clinical coordinator openings that are location-eligible for New York.

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Clinical Quality Improvement Coordinator

Guide Healthcare

Leading a movement where creativity delivers positive change. Learn more guidehealthcare.com.au

Clinical Coordinator3 days ago

Full Time Remote JuniorTeam 51-200Since 2018H1B No Sponsor

Company Site LinkedIn

• Work in a fully remote environment and virtually engage with company and team in your daily work. • Subject Matter Expert (SME) on entire scope of QI measures, services, customers and quality initiatives under various commercial and governmental payers. • Conduct proactive patient outreach initiatives to identify and address quality gaps, engaging with patients to educate them on preventive care measures, schedule necessary screenings or appointments, and facilitate adherence to treatment plans, thereby contributing to improved health outcomes and closing quality gaps. • Collect quality data using various methods of data sourcing-EMR, claims, provider outreach. • Manage daily work using multiple systems and applications-EMR systems, payer portals, vendor platforms, Guidehealth applications, Microsoft 365 for Excel, Word and PowerPoint and Teams for messaging and meetings. • Work with patient lists, gap lists, sourced health data and medical records in your daily work. • Leverage all quality related resources to ensure accuracy and completeness of work measure/project instructions, NCQA/HEDIS® specifications, coding documents, quick reference guides. • Prioritize daily work to meet various quality reporting deadlines and requirements. • Communicate quality performances, barriers and improvement strategies both internally and with customers. • Follow all established policies and procedures for various QI workflows to ensure overall success. • Collaborate w/ customers, payers, co-workers to accomplish daily work. • Participate in all departmental and payer sponsored webinars/trainings/support calls throughout the year. • Communicate professionally and develop positive relationships with co-workers, customers, providers and providers’ support staff.

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United States

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Appeals Coordinator

Lifepoint Health

Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country. We employ and provide care to people from all walks of life. We are committed to promoting healing, providing hope, preserving dignity and producing value with an inclusive workforce in which diversity is leveraged, respected, and reflective of the patients, family members, customers and team members we serve.

Clinical Coordinator11 days ago

Full Time Remote Mid LevelTeam 1,001-5,000

Role Description The Appeals Coordinator gathers all information required for an appeal, writes, and submits the appeal to the insurance company, makes follow-up phone calls, and maintains documentation of all steps taken. The Appeals Coordinator uses clinical criteria guidelines and clinical documentation to develop sound and well-supported appeal arguments to support medical necessity. The Appeals Coordinator works independently and collaboratively with other departments to positively affect clinical and financial outcomes. - Display knowledge of clinical pertinence and managed care requirements to support medical necessity criteria for inpatient and outpatient levels of care. - Verify the information needed by the insurance plan for an appeal, where to submit the appeal, and method of submitting appeal. - Manage large volumes of documents including copying, faxing and scanning incoming mail. - Document and log information on tracking systems and mainframe systems. - Ensure appeals are completed thoroughly and on a timely basis. - Interface with managed care organizations, external reviews, and other payers. - Obtain access to various provider portals and utilize portals for submitting appeals and following up on status of appeals when applicable. - Communicate with facility UR staff when needed to efficiently complete the appeal process. Qualifications - Bachelor’s Degree in social work, RN or degree in a related behavioral health field. - Minimum of 2 years of experience in a managed care/healthcare setting. Requirements - Previous utilization review experience in a psychiatric healthcare facility preferred. - Computer proficiency in Microsoft Office applications and other software programs essential to perform job functions. - May be required to work flexible hours and overtime. Benefits - Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees. - Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off. - Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match. - Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs). - Professional Development: Ongoing learning and career advancement opportunities.

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Clinical Appeals Coordinator

Peak Health

Helping you reach new heights

Clinical Coordinator16 days ago

Full Time Remote SeniorTeam 51-200H1B No Sponsor

Company Site LinkedIn

• Investigate and process medical necessity requests from both members and providers • Conduct and lead investigations and reviews for member and provider medical necessity appeals • Review the medical record of denied services for medical necessity • Provide a summary of case for the medical director, and other partners in the health plan care team • Ensure that appeal timeframes are met and meet the standards of enterprise, state, and federal standards and requirements • Document and log case information for the appeal • Generate the written response to the member or provider • Serve as a subject matter expert for appeals and grievances

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Clinical Appeals Coordinator

WVU Medicine

Clinical Coordinator17 days ago

Full Time Remote Senior

Company Site

• Investigate and process medical necessity requests from both members and providers • Conduct and lead investigations and reviews for member and provider medical necessity appeals • Review the medical record of denied services for medical necessity • Provide a summary of case for the medical director and other partners in the health plan care team • Ensure that appeal timeframes are met and meet the standards of enterprise, state, and federal standards and requirements • Document and log case information for the appeal • Generate the written response to the member or provider • Serve as a subject matter expert for appeals and grievances • Commit to a career of life-long learning and continuous improvement of processes related to Utilization Review

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Clinical Coordinator

Rasmussen University

Rasmussen University is a for-profit, private institution of higher learning offering bachelor's and associate's degrees from campuses across Minnesota and in s

Clinical Coordinator17 days ago

Full Time Remote Mid Level

Company Site

• Ensure Clinical Experiences Support Curriculum Delivery (50% or more) • Build relationships with health care facilities and potential adjunct faculty. • Collaborate with Dean of Nursing, Area Dean of Nursing, or Regional Dean of Nursing to identify clinical experiences that are evidence-based; reflect contemporary practices and nationally established patient health and safety goals; and support the achievement of the end-of-program student learning outcomes. • Review written agreements for clinical practice agencies to ensure they are current, specify expectations for all parties, and ensure the protection of students. • Review evaluation findings related to clinical experiences and report them to the Dean of Nursing, Area Dean of Nursing, or Regional Dean of Nursing. • Collect, document and store all required student programmatic paperwork according to University and programmatic policies. • Assist with the clinical course scheduling as directed by Nursing Deans. • Collaborate with the campus staff to assign student clinical placement and collect required documentation. • Track and maintain all community-based activities in Sales Force as appropriate, utilizing the Clinical Tracking Tool as the primary database for clinical activities and documents of record. • Work collaboratively across program, school, and campus in order to maximize community clinical relationships for Rasmussen stakeholders. • Participate in campus, community and professional events to represent Rasmussen University to students, professional organizations, community partners, and other relevant constituencies within the communities. • Assist students with clarification of clinical attendance requirements of the program. • Maintain and monitor active, clinical partnership agreements in order to ensure sustained and non-interrupted student access to sites. • Work collaboratively with the Rasmussen legal and compliance team to ensure a going concern of contracts and agreements. • Assist Dean with data collection related to the achievement of the end-of-program student learning outcomes directly related to clinical learning experiences.

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