- CenterWell (Albany, NY)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… 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...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… 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 to ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … 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 ... reviews and may require peer-to-peer discussions with providers regarding UM case review determinations. + Provides clinical expertise on...and medical criteria. + Assists with training medical director colleagues and nursing staff ,… more
- Molina Healthcare (NY)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM ...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Molina Healthcare (Buffalo, NY)
- JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting ... and cost-effective member care. Essential Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …external standards set by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case ... refers potential quality of care and utilization issues to Medical Director . + Utilizes appropriate communication techniques...5 years. + Broad understanding of multiple areas (ie UM and CM). Incumbent is required to know multiple… more
- Bassett Healthcare (Cooperstown, NY)
- …required by institutional guidelines + Make recommendations for improvement to Director Case Management + Ensures compliance with all regulatory agency requirements ... with departmental and institutional policies + Collaborates with the Director of Care Coordination on the development, review, and...(charge nurse, staff nurse) unit manager, and support team ( UM , MSW, SW, etc) to progress each patient's care… more
- Datavant (Albany, NY)
- …appropriate letter language to author appeal letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted ... + Work directly with the provider(s) and health plan Medical Director as needed to facilitate timely...table:** + Two (2) years managed care experience in UM /CM/CDI Department preferred + Knowledge of CMS, State Regulations,… 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 ... members. + Through collaborative efforts the Case Manager will identify the medical and psycho-social needs of designated members, act as a proactive partner,… more
- ULTRA ELECTRONICS OCEAN SYSTEMS INC. (Victor, NY)
- …front-end modules, and digital signal processing electronics. Reporting to the Director of Electrical Engineering, you would provide leadership that fosters ... project execution challenges + Ensure all staff and programs comply with UM US engineering processes, policies, and standards + Provide technical oversight and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director , Pharmacist, Geriatrics, etc.) to ensure continuity ... for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards, as appropriate to… more