- MetroPlusHealth (New York, NY)
- …the medical necessity of requested healthcare servicesCommunicates with Medical Director regarding all inpatient cases and outpatient/ambulatory requests ... including, but not limited to, New York State Medicaid Managed Care, Medicare , Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan,… more
- Molina Healthcare (Yonkers, 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 (Yonkers, 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
- CVS Health (New York, NY)
- …supports over 6 million members on its core administrative platforms. The Lead Director , Technology Product Management for our Medicare Enrollment & Billing will ... tech-ops, security, etc. to ensure overall cohesion for the Medicare claims platform. You will lead a team of...our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company… more
- Molina Healthcare (Yonkers, 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
- Mount Sinai Health System (New York, NY)
- **Job Description** **Mount Sinai Health System is seeking a Medical Director of Physician Engagement and CDQI!** **Background:** Mount Sinai is one of the ... improve the status quo **Role Summary:** MSHP seeks a Medical Director (MD), Physician Engagement and CDQI,...all populations served, especially our patients covered under a Medicare arrangement (MSSP or MA). The MD will report… 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...a Health Care Innovation Award from the Centers for Medicare and Medicaid Services to open the first geriatric… 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 ... implementation of performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals and policies… more
- New York State Civil Service (New York, NY)
- …facility, is recruiting a Clinical Director , Psychiatric Center, M-8. The Clinical Director serves as the facility's Chief Medical Officer and is responsible ... NY HELP No Agency Mental Health, Office of Title Clinical Director , Psychiatric Center, M-8, New York State Psychiatric Institute, P27140 Occupational Category… more
- Molina Healthcare (Yonkers, 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
- Ankura (New York, NY)
- …accreditations, operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment. The Senior Director ... to complex litigation, enforcement, and regulatory challenges. Role Overview The Senior Director will support the Healthcare Payer team within Ankura's Disputes &… more
- Molina Healthcare (Yonkers, 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 (Yonkers, NY)
- …with the standards and requirements established by the Centers for Medicare and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the ... to members or authorized representatives in accordance with Centers for Medicare and Medicaid standards/requirements. * Provides direct oversight, monitoring and… more
- Option Care Health (New York, NY)
- …Allergy/Immunology specialties + Understanding of billing and reimbursement procedures for medical offices and hospitals (Commercial Insurance, Medicare Part B ... best and brightest talent in healthcare. **Job Description Summary:** The Area Sales Director will develop and implement the Chronic business sales plan that aligns… more
- Robert Half Finance & Accounting (New York, NY)
- …those most impacted by social determinants of health. Our client is seeking a Director of Finance to serve as a strategic and hands-on leader, reporting directly to ... cycle management and ensure accurate billing, coding, and claims across Medicaid, Medicare , and private insurers . Guide long-term financial strategy to support… more
- Insight Global (New York, NY)
- Job Description About the Role: As Director of Payer Enrollment, you will play a crucial role in the leadership of our Payer Enrollment team. Our PE Team is core to ... subsequent action plans. The role will report directly to the Senior Director of Operations. Responsibilities: * Develop and manage Payer Enrollment leaders at… more
- The New Jewish Home (Bronx, NY)
- …The HAPI Division of The New Jewish Home is seeking for a full time Director of Patient Care to join our team. Job Summary: Oversees all clinical operations, ... improvement activities, training and supervision of nursing and field staff and medical compliance issues. Reports To: AVP, Home & Community Based Services and/or… more
- Humana (New York, NY)
- …talent seeking enterprise visibility, strategic influence, and accelerated career growth. As the Director , Office of the CEO, you will work directly with the Chief ... your life extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan, time off (including… more
- Molina Healthcare (Yonkers, 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
- Option Care Health (Manhattan, NY)
- …is maintained by providing direct patient care 20-40% of the time. In a Medicare Certified Home Health agency, this position may also serve as the alternate ... administrator and or alternate director of nursing. **Job Description:** **Job Responsibilities** (listed... of Nursing of the Home Health Agency for Medicare certified home health agencies in the absence of… more
