- Humana (Albany, NY)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... in accordance with Medicare and Humana policy. **Please note that this Medical Director position is non-benefitted, and compensated hourly * **Use your… more
- 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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … 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...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- CVS Health (Albany, NY)
- …"base plan" and in the round robin based on "same or similar specialty" needs. * Pharmacy coverage - The medical director will perform pharmacy reviews. ... services to its membership. Aetna is looking for a medical director to be part of a...Two (2) + years of experience in managed care ( Medicare and/or Medicaid) MD or DO; Board certification in… 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 ... experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +...provider contracting experience. + Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice,… more
- Merck (Albany, NY)
- …with HSO MADs + Serves as a resource for the PM MAD-HSO Team Lead, HSO Executive Director Medical Affairs, and other members of US Medical Affairs on other ... **Job Description** + The Precision Medicine - Medical Affairs Director - Health Systems...research \#eligibleforERP **Required Skills:** Benefit Programs, Clinical Data, Clinical Pharmacy , Clinical Studies, Medical Affairs, Medical… more
- Molina Healthcare (Albany, 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 (Albany, NY)
- …under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy ... JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and ...leadership and quality improvement teams. * Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. * Reviews… more
- Molina Healthcare (Albany, NY)
- …including clinical practice experience, and at least 2 years as a medical director in managed care organization supporting utilization management/quality program ... level strategy and leadership to a national business segment (ie Medicare , Marketplace, advanced imaging/central utilization management services) in the development… more
- Grifols Shared Services North America, Inc (Albany, NY)
- …calls include but are not limited to: Neurologists, Immunologists, Allergists, Specialty Pharmacy companies, Infusion Center and Hospital accounts like pharmacy ... business customers. The SSR will liaise with Marketing, Managed Markets, Operations, CL&D, Medical Affairs and Telesales to achieve the goals of the company. The SSR… more