- MVP Health Care (Rochester, NY)
- …care. The Case Manager will also monitor and review cases with the Medical Director to ensure appropriate outcomes. Service Authorization & Review: Conduct ... thinking and continuous improvement. To achieve this, we're looking for a Case Manager, Medicaid Long Term Support Program to join #TeamMVP. If you have a passion… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Humana (Albany, NY)
- …to adapt and the courage to innovate **Additional Information** Reports to the Lead Medical Director - North Central Medicaid Markets. The Medical ... caring community and help us put health first** The Medical Director relies on medical ...Medical Directors will learn North Central region state Medicaid requirements (currently VA, KY, OH, IN, WI) and… more
- Humana (Albany, NY)
- …party reporting including notification, collection, analyze, storage, and distribution. + Team representative and presenter for various Medicaid committee ... caring community and help us put health first** The Associate Director , Procurement generates and implements efficient sourcing and category management strategies.… more
- New York State Civil Service (New York, NY)
- …No Agency Attorney General, Office of the Title Legal Nurse: Investigate Medicaid Fraud/Patient Abuse (6400) Occupational Category Legal Salary Grade NS Bargaining ... Office of the New York State Attorney General's (OAG) Medicaid Fraud Control Unit (MFCU) is seeking experienced Registered...(MFCU) is seeking experienced Registered Nurses to serve as Medical Analysts in its New York City office. … more
- NTT DATA North America (Albany, NY)
- …adaptable, and forward-thinking organization, apply now. We are currently seeking a Senior Medicaid Solution Architect to join our team in Albany, New York ... Operations & Systems The Senior Solution Architect will report to the Technology Director for the Division of Operations and Systems and have responsibility for… more
- MVP Health Care (Schenectady, NY)
- …care. + The Case Manager will also monitor and review cases with the Medical Director to ensure appropriate outcomes. + Service Authorization & Review: Conduct ... team at ###@mvphealthcare.com . **Job Details** **Job Family** ** Medical Management/Clinical** **Pay Type** **Salary** **Hiring Min Rate** **56,200 USD**… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … more
- Humana (Albany, NY)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...consistency in outcomes, consumer experiences, and a highly engaged team culture + Knowledge and experience with national guidelines… more
- Humana (Albany, NY)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...consistency in outcomes, consumer experiences, and a highly engaged team culture** + **Knowledge and experience with national guidelines… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …you see is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical ... and medical criteria. + Assists with training medical director colleagues and nursing staff ,...propose new medical policies, in conjunction with Medical Services team and Medical … more
- Evolent (Albany, NY)
- …meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Albany, NY)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management ... team . We can offer you a meaningful way to...per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to… more
- Centene Corporation (New York, NY)
- …quality accreditation standards. + Actively practices medicine **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical ... 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
- Mount Sinai Health System (Queens, NY)
- …York City H+H Queens Hospital Center (QHC) has an exciting opportunity for a Medical Director of SUD Services.** QHC serves the culturally diverse community of ... new Psychiatry Residency Program launching July 2025. The SUD Director will join this leadership team and...management of QHC SUD Services. + Will join the Medical leadership team of Behavioral Health. +… more
- Evolent (Albany, NY)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a key member of the utilization management ... team . We can offer you a meaningful way to...timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to… more
- WellLife Network (Old Field, NY)
- Deputy Director of Residential Programs - CRS008 - Mon-Fri 9AM-5PM w/ flexibility Job Details Job Location Setauket Community Residence - Setauket, NY Secondary Job ... thrive and realize their fullest potential. Position SummaryThe Deputy Director provides operational leadership and administrative oversight for three OMH-licensed… more
- Molina Healthcare (Buffalo, NY)
- …3+ years HMO/Managed Care experience **OR** 5 years experience as a Molina Medical Director + Demonstrated experience in Utilization/Quality Program management + ... Medical License without restrictions (free of sanctions from Medicaid or Medicare) **PREFERRED EDUCATION:** Master's in Business Administration, Public Health,… more
- Mount Sinai Health System (New York, NY)
- …Description** **The Mount Sinai Health System seeks an Obstetrics and Gynecology System Medical Director for its Ambulatory Services at Mount Sinai Hospital!** ... status for nursing care, and it is the only medical center in New York State to earn Disease-Specific...Care Innovation Award from the Centers for Medicare and Medicaid Services to open the first geriatric emergency department… more
- Evolent (Albany, NY)
- …recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... will be a key member of the utilization management team . We can offer you a meaningful way to...Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests… more
