• Corporate Medical Director

    Humana (Albany, NY)
    …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 problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
    Humana (09/05/25)
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  • Medical Director - Medicare

    Humana (Albany, NY)
    …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 problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
    Humana (10/02/25)
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  • Director , Appeals & Grievances

    Molina Healthcare (Buffalo, NY)
    …with the standards and requirements established by the Centers for Medicare and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the ... activities of the Appeals & Grievances unit that is responsible for reviewing and resolving member complaints and communicating resolution to members or authorized… more
    Molina Healthcare (09/26/25)
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  • Medical Director ( Medicare )

    Molina Healthcare (Rochester, NY)
    …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care....experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
    Molina Healthcare (09/12/25)
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  • Therapy Aide

    WMCHealth (Margaretville, NY)
    …+ Keep abreast of economic conditions/situations and recommend to the Activity Director adjustments in activity programs that assure the continued ability to provide ... forms, reports, etc., and submitting such to the Activity Director as required. + Committee Functions + Serve on,...before entering a resident's room. + Review complaints and grievances made by the resident and make a written/oral… more
    WMCHealth (10/01/25)
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  • Registered Nurse - Clinical Appeals & Denials…

    Cognizant (Albany, NY)
    …. Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing medical necessity denials for resolution. You will be a... Medicare , Medicaid, and third-party guidelines. . Effectively document and… more
    Cognizant (10/09/25)
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  • Accounting Manager

    Loretto Management Corporation (Syracuse, NY)
    …and procedures, and third party agency regulations. + Applies knowledge of various Medicare , Medicaid, and other third party billing rules. + Keeps current knowledge ... personnel, including performance management, scheduling, and orientation. With the Director and Human Resources guidance, makes or approves recommendations on… more
    Loretto Management Corporation (08/25/25)
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