- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and ... reviewing home health, SNF, DME, dual Medicare/Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether… 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...data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical… 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 ... how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to complex clinical… 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 ... how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to complex clinical… more
- Evolent (Albany, NY)
- …business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of the Medical ... development of questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into the types of cases to review.… more
- CVS Health (Albany, NY)
- …NJ License without encumbrances or the ability to obtain a NJ License. In the Medical Director role you will provide oversight for medical policy ... ensuring timely and consistent responses to members and providers. As a Medical Director you will focus primarily on overseeing utilization review / quality… more
- CVS Health (Albany, NY)
- …have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical ... staff ensuring timely and consistent responses to members and providers. As a Medical Director you will focus primarily on review appeal cases for denied … more
- 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 scope and complexity ranging from moderate to substantial. The Corporate … more
- MVP Health Care (Schenectady, NY)
- Medical Director , Clinical Review and Care Integrity 625 State St, Schenectady, NY 12305, USA * Rochester, NY, USA * Tarrytown, NY, USA Req #2635 Tuesday, June ... thinking and continuous improvement. To achieve this, we're looking for a ** Medical Director , Clinical Review and Care Integrity** to join #TeamMVP. If you have… more
- Evolent (Albany, NY)
- …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. ... 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)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... 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 Field Medical Director , MSK Surgery you will be a specialty match reviewer for Spine ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Grifols Shared Services North America, Inc (Albany, NY)
- …and services in more than 110 countries and regions. **Position Overview:** The Medical Director will be responsible for clinical strategy relating to upcoming ... of human disease. **Pay Scale:** The estimated pay scale for the Medical Director (1-2) role based in the United States (non-California), is $170,000.00 -… more
- Elevance Health (Latham, NY)
- **Clinical Operations Associate Medical Director ** **Carelon Medical Benefits Management** **** **Virtual:** This role enables associates to work virtually ... of care for the people we serve._ The **Clinical Operations Associate Medical Director ** is responsible for supporting the medical management staff ensuring… more
- 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 scope and complexity ranging from moderate to substantial. The Corporate … more
- St. Mary's Healthcare (Amsterdam, NY)
- …Physician to lead our program at St. Mary's Hospital in Amsterdam, NY. The medical director is responsible for managing, directing and coordinating all aspects ... choice! Compensation: + $240.00 per hour (Days) + $250.00 per hour (Nights) + Medical Director Stipend: up to $15,000/month As an Emergency Medicine Medical … more
- Molina Healthcare (Albany, NY)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... years relevant experience, including: + 2 years previous experience as a Medical Director in a clinical practice. + Current clinical knowledge. + Experience… more
- Sumitomo Pharma (Albany, NY)
- …seeking a dynamic, highly motivated, and experienced individual for the position of **Associate Medical Director .** The Associate Medical Director will ... for SMPA investigational and commercial products. The incumbent will provide medical safety support for safety signal management throughout product lifecycle… more
- Evolent (Albany, NY)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be a key member of the utilization ... a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process,… more