Natixis is searching for a vp- or director-level Loan Review Officer to join the New York team to help support the Managing Director and other team members in our various credit examination activities and reporting needs.

Responsibilities include execution of Business Monitoring and Reviews in accordance with the Fundamental Credit Review (FCR) Manual and GPR Methodology. Within GRR, the Global Portfolio Review (GPR) function provides an independent review and challenge of risks in frameworks or processes that span multiple portfolios, risk stripes, or encompass the entirety of Citi.

Under the general supervision of the case management director, the Utilization Review Nurse acts as a patient and organizational advocate. The Utilization Review Nurse assists the nurse case manager, social worker, and physician to insure the right care is provided at the right time every time by focusing on the person and family and ensures the patient's active participation and decision making in their care.

Under the direction of the Director of Admissions & Utilization Review, the Utilization Review Specialist will coordinate Medicaid Managed Care benefits and approvals for clients receiving behavioral healthcare services from Odyssey House's Part 820 residential programs.

Under limited supervision, the Coding Review Specialist will coordinate, monitor, and perform documentation and coding audits of inpatient and/or outpatient services in all applicable health care settings.

We offer the following benefits to support you and your family:Free Premium Membership to our Care@Work program to help employees with child care pet care senior caregivers housekeepers & more.

The Coding Review Specialist will analyze audit results, identify patterns, trends or variations in coding and documentation practices, and make recommendations for improvement. Certified Risk Adjustment Coder (CRC) credentialPreferred Qualifications:+ Minimum five (5) years of coding and/or auditing experience across multiple health care delivery settings (e.g., office/clinic, hospital inpatient, hospital outpatient, ambulatory surgery center.

The Utilization review tech will further support the department needs for Release of Information, discharge coordination or other duties as assigned. Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers.

Within GRR, the Global Portfolio Review (GPR) function provides an independent review and challenge of risks in frameworks or processes that span multiple portfolios, risk stripes, or encompass the entirety of Citi. Reporting to the Head of GPR, the Credit Review Senior Officer is responsible for independently managing all aspects of assigned Review Entities.

Responsibilities include coordination and management of the activities of the RRC; management of the meetings of the RRC, including preparation of meeting agendas, coordination of committee reviewer assignments, monitoring of attendance and production of minutes; ensuring all materials required for committee review are complete; oversight of the committee correspondence and ensuring completion of committee tasks; aiding in maintaining accurate records for clinical trial reporting.

Send review to Medical Director for rescinding NOMNC when necessary, following naviHealth processes. plays an integral role in optimizing the patient's recovery journey by providing a comprehensive review of a member's clinical information in response to an appeal from the Quality Improvement Organization (QIO) or the health plan.

Responsibilities:FTZ Administrator, Operations, and Compliance Review Specialist will be involved in the FTZ daily duties, which will include the following:+ Review or prepare FTZ admissions (e-214.

Review NOMNC for validity before processing appeal requests. Ensure second-level reviews have been performed and documented and may confer with medical directors, Health Plan Manager(s), Inpatient Care Coordinators (ICC's), Skilled Inpatient Care Coordinators (SICC's), Pre-service Coordinators (PSC's) and facility personnel in determining denial information is processed timely and appropriately utilizing naviHealth proprietary technology.

This role is responsible for performing transaction activity reviews, investigations and customer due diligence reviews on customers that have been alerted for potentially suspicious activity, potential sanctions list matches or that have been identified as posing elevated risk for money laundering and terrorist financing.

For example, a doctor is treating a patient; after treatment the Utilization Review Nurse will assess if the patient still needs to stay in the hospital or be sent home. The Utilization Review Nurse evaluates the patient’s situation against the hospital policies, insurance company’s standards and the cost of involved treatments.