- Humana (Albany, NY)
- …a Lead Medical Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care ... **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement… more
- CenterWell (Albany, NY)
- …us put health first** The Medical Director , Primary Care relies on medical background and reviews health claims . The Medical Director , Primary ... The Medical Director relies on medical background and reviews health claims . The...the Director of Physician Strategy at Utilization Management . The Medical Director conducts… more
- Humana (Albany, NY)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in the… more
- Humana (Albany, NY)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
- Guthrie (Cortland, NY)
- …as necessary with the hospital Business Office, physician offices, Care Coordination, Medical Director and other hospital departments as appropriate. + Serves ... Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination,...requirements and to assist in ensuring generation of clean claims in a timely manner + Securing authorization as… more
- WTW (New York, NY)
- …clients of their claim related obligations under the policy and establish client-specific claims management procedures + Provide claims advocacy on behalf ... **Description** **The Role** This role provides value-added claims leadership and management service for the management liability lines of coverage, acts as… more
- MTA (Brooklyn, NY)
- …TA/OA Department: Law Division/Unit: Torts Reports to: Assistant General Counsel / Director of Claims Work Location: 130 Livingston Street, Brooklyn Hours ... aid defense counsel; reviewing and drafting reports for senior management ; serving as liaison between the torts department and...damage claims brought against MTA agencies. Review claims and relevant factual and medical records… more
- MTA (Brooklyn, NY)
- …and reduce overall costs. Some of the major responsibilities include supervising the TPA's claims management and medical provider networks as well as ... Assistant Director - Workers Compensation (Case Management )...Minimum 8 years progressively responsible experience in Workers' Compensation claims management and administration. At least 4… more
- Otsuka America Pharmaceutical Inc. (Albany, NY)
- …the asset lifecycle. This role reports directly into the Executive Director , Medical Excellence and Operations. **Job Description** **Key Responsibilities ... The Director , Strategic Planning & Operations is a pivotal...multi-year strategic roadmaps tailored to each therapeutic area **Budget Management ** + Oversee budgets for global medical … more
- CVS Health (Albany, NY)
- …cover urgent cases can be done from your laptop. **Fundamental Components:** * Utilization management - The medical director will perform concurrent and ... services to its membership. Aetna is looking for a medical director to be part of a...licensure a plus. **Preferred Qualifications:** Previous Experience in Utilization Management / Claims Determination with another Health… more
- Merck (Albany, NY)
- **Job Description** The Oncology Regional Medical Scientific Director , Oncology is a credentialed (ie, MD, PhD, PharmD, or DNP) therapeutic and disease expert ... about any drug, vaccine or biologic product. The Oncology Regional Medical Scientific Director provide to Scientific Leaders balanced, factual, scientific… more
- Otsuka America Pharmaceutical Inc. (Albany, NY)
- **Job Summary** The Senior Director , Mature Assets Lead within the CNS medical business unit (BU) is a critical role responsible for shaping the strategic ... to balance competing priorities. This position reports directly to the Executive Director , CNS Medical BU Lead. **Job Description** **Key Responsibilities… more
- Otsuka America Pharmaceutical Inc. (Albany, NY)
- The Director , Congress and Medical Education Strategy & Execution is responsible for developing and leading the global medical strategy and tactical ... outcomes through deep scientific understanding and collaborative partnerships. The Director partners closely with global and regional cross-functional stakeholders -… more
- Mount Sinai Health System (New York, NY)
- …patient outcomes while controlling costs. The Director collaborates closely with medical staff, vendors, case management , and payers to secure payment and ... **Job Description** ** Director Pre Appeals Management -HSO Appeals ...**Preferred Qualifications (Industry-Specific)** : + Healthcare: Experience with utilization management for medical services, procedures, or medications… more
- Otsuka America Pharmaceutical Inc. (Albany, NY)
- The Senior Director , Medical Affairs Solutions & Analytics provides oversight and spearheads Global Medical Affairs (GMA) business enablement and analytic ... efficient Medical Affairs operations as needed, including Medical customer relationship management , insights management...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Centene Corporation (New York, NY)
- …the Chief Medical Director to direct and coordinate the medical management , quality improvement and credentialing functions for the business unit. + ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a...performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …the Chief Medical Director to direct and coordinate the medical management , quality improvement and credentialing functions for the business unit. This ... implementation of performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals and policies… more
- WMCHealth (Poughkeepsie, NY)
- …event, an aberrant practice pattern, a potential lawsuit, etc.) and alerts the department director , medical staff leadership, and claims manager. + Conducts ... an aberrant practice pattern, a potential lawsuit, etc.) and alerts the department director , administration, and the claims manager. Initiates a more thorough… more
- Molina Healthcare (NY)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Humana (Albany, NY)
- …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 problems of diverse scope and complexity...focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with… more