- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health ... claims and preservice appeals. The Corporate Medical Director works on...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health ... claims and preservice appeals. The Corporate Medical Director works on...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Humana (Albany, NY)
- …Information** Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director , depending on size of region or line ... caring community and help us put health first** The Medical Director relies on medical ...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Centene Corporation (Queens, NY)
- …implementation and performance monitoring. The position will collaborate cross-functionally with corporate Service Fund and National Medicare contracting teams ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- Northwell Health (Westbury, NY)
- **Req Number** 158136 Job Description The Director , Corporate Finance (RIO) promotes the financial viability of Northwell Health by effectively managing the ... organization's revenue capture operations. The Director works in close partnership with many aspects of...accuracy and regulatory compliance. Job Responsibility + Leads a Corporate Finance group by communicating with, developing, and training… more
- CVS Health (Albany, NY)
- …We are looking for a Principal Data Scientist to join our Aetna Medicare (STARS Portfolio) team at CVS Health. This high-level individual contributor will partner ... closely with the Executive Director of Aetna STARS Analytics to drive hands on...business strategies and products + Experience in large, matrixed corporate environment + Experience working with end-users **Education:** +… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Billing Director -Patient Financial Services- Corporate (ON SITE) Full-Time -Days** Responsible for direction and management responsibility ... the business and operational activities of a department or medical care unit. **Qualifications** + 5 or more years...standards and billing regulations set by governmental agencies like Medicare and Medicaid. + May chair or participate in… more
- Humana (Albany, NY)
- …Information** Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director , depending on size of region or line ... caring community and help us put health first** The Medical Director relies on medical ...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …and implementation of the Children's Behavioral Health (BH) Carve-In program. The Medical Director for BH Children's Services has overall accountability for ... of the Quality Management/Utilization Management (QM/UM) Plan, including having the BH Medical Director for Children's Services and participate on the BH… more
- Catholic Health Services (Melville, NY)
- …(UR), discharge planning (DP), LOC and clinical documentation. Works with Corporate Compliance to interpret new regulatory and compliance requirements and develops ... Qualifications: 1. Minimum Education/Training Required: Graduate of an accredited medical school. Completion of specialty residency (ie, Internal Medicine, Emergency… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director , Pharmacist, Geriatrics, etc.) to ensure continuity ... Description: Summary: Conducts case management program activities in accordance with departmental, corporate , NYS Department of Health (DOH), Centers for Medicaid & … more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director , Pharmacist, Geriatrics, etc.) to ensure continuity ... Description: Summary: Conducts case management program activities in accordance with departmental, corporate , NYS Department of Health (DOH), Centers for Medicaid & … more
- Excellus BlueCross BlueShield (Rochester, NY)
- …+ Conducts comprehensive reviews and documentation of findings for submission to the medical director for final determination, as required by law. + Provides ... supports all of our lines of business which include Medicare , Commercial, Exchange (Marketplace) and Medicaid. The focus of...and cost of medications for our members through the medical management of drugs across our pharmacy and … more
- Grifols Shared Services North America, Inc (Albany, NY)
- …business customers. The SSR will liaise with Marketing, Managed Markets, Operations, CL&D, Medical Affairs and Telesales to achieve the goals of the company. The SSR ... and commercial insights and monthly business planning discussions with Regional Sales Director *Better use of existing tools like Excel, Word *Use of Technology… more