- 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 ... Medicaid members. Through collaborative efforts the Case Manager will identify the medical and psycho-social needs of designated members, act as a proactive partner,… more
- Molina Healthcare (Rochester, NY)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Molina Healthcare (Rochester, NY)
- …3+ years HMO/Managed Care experience **OR** 5 years experience as a Molina Medical Director + Demonstrated experience in Utilization/Quality Program management + ... Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and… more
- Molina Healthcare (Rochester, 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
- Molina Healthcare (Rochester, NY)
- **JOB DESCRIPTION** **Job Summary** Responsible for analysis of Medicaid and Medicare financial reports, trend, and opportunities. Includes evaluation of and ... recommendations relating to business opportunities, Medicare bids, investments, financial regulations, and similar financial projects...early signs of trends or other issues related to medical care cost. + Design and perform actuarial studies… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director , Pharmacist, Geriatrics, etc.) to ensure continuity ... departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for… more
- Molina Healthcare (Rochester, NY)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Molina Healthcare (Rochester, NY)
- …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... (TX) Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review, medical policy/procedure development, provider… more
- Molina Healthcare (Rochester, NY)
- …reviews behavioral health portions of state contracts. * Assists behavioral health medical director lead trainers in the development of enterprise-wide education ... JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health...National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS). * Assists with the… more
- Molina Healthcare (Rochester, NY)
- …and Joint Operating Committees. * Manages and reports network adequacy for Medicare , Marketplace, and Medicaid services. * In conjunction with direct management and ... recontracting initiatives. Implements cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region. * Leads preparation… more
- St. John's Embrace Living (Rochester, NY)
- …organizes time and resources efficiently + Technical expertise in all forms of medical billing, including Medicaid, Medicare and other third party payers ... Position Summary: The Billing Specialist position reports directly to the Director of Finance and will work within a team environment to complete the submissions,… 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 ... identifies and refers potential quality of care and utilization issues to Medical Director . + Utilizes appropriate communication techniques with members and… more
- Danaher Corporation (Rochester, NY)
- …engagement and responding to customer inquiries. This position reports to the Senior Director Market Access Americas and is part of the Value and Access team. ... + Communicate regional and local coverage and reimbursement issues for Medicare , Medicaid and Commercial payers through internal meetings, payer research, and… more
- University of Rochester (Rochester, NY)
- …health counseling) to identify high-risk patients with behavioral health and medical comorbidities, and facilitates access to other specialty psychiatric and ... therapy accordingly. - Meets minimum target for clinical productivity set by service director and Division. - Documents treatment in patient's electronic medical … more
- 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 ... members. + Through collaborative efforts the Case Manager will identify the medical and psycho-social needs of designated members, act as a proactive partner,… more
- Rochester Regional Health (Rochester, NY)
- …- 4:30PMSUMMARY Participates and supports oversight of office processes of the Medical Management Department to maintain daily operations. Oversees the daily review ... process of third party payors with oversight from the Director of Care Management. Provides daily oversight of the...Party Payors are maintained. + Participates and supports the medical management department in the tracking, trending and reporting… more
- Molina Healthcare (Rochester, NY)
- …with national quality and risk adjustment VPs, Regional Directors of Quality/Risk, Director of Value Based Programs, and local health plan resources. + Responsible ... program & contract design and implementation for marketplace, Medicaid and/or Medicare + Experience in a complex healthcare delivery environment, specifically with… more
- HCR Home Care (Rochester, NY)
- …documentation of such conferences via the Case Conference Coordination Note in the medical record . + With the assistance of the Clinical Field Staff Supervisor ... patient . + In collaboration with the HR Department and Regional Director , participate in recruitment of qualified personnel and implementation of effective… more
- New York State Civil Service (Canandaigua, NY)
- …will include evaluating individuals' needs and interests; as well as medical health care services and treatment, and social/leisure support services. The ... and maintain eligibility for full and unconditional participation in the Medicare and Medicaid programs. Continued employment will depend on maintaining eligibility.… more
