- Molina Healthcare (Yonkers, NY)
- …with the Service Level Agreements between the parties. **Job Duties** + Develops Medicare and Medicaid vendor strategies aligned with CMS and State regulations, ... **Job Summary** This position is responsible for the holistic management of the external vendor relationships for Claims and Enrollment activities (along with other… more
- Staffing Solutions Organization (Albany, NY)
- …which may be received from a variety of sources such as Centers for Medicare and Medicaid Services ( CMS ), Insurance Carriers, and others. + Ability to ... & Marketplace Integration (DEMI)** **Bureau of Third-Party Health Insurance, Medicare Savings Program and Recoveries** **Telecommuting Option:** This position is… more
- Molina Healthcare (Syracuse, NY)
- …building regulatory compliance audit procedures. * At the direction of management , coordinates and performs oversight audits and validation activities to ensure ... other evidence as part of regulatory audits. EX: DMHC, CMS active audits. Responsible for acting as the liaison...Provides draft written reports of audits and findings to management , including recommendations for any identified finding; Supports … more
- Healthfirst (Enfield, NY)
- …follow up with updates when needed. + Strictly adhere to all CMS regulations and Healthfirst marketing guidelines. + Ensure all documentation is complete, ... Application Submission Form, and Salesforce. + Provide competitive intelligence to management on any activities Healthfirsts market competitors are engaging in: eg… more
- Humana (Albany, NY)
- … management + Utilization management experience in a medical management review organization such as Medicare Advantage, managed Medicaid, or Commercial ... health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve… more
- Molina Healthcare (Yonkers, NY)
- …Google or Adobe analytics (or similar) Google AdWords, Tag Manager systems, (Adobe or Google) CMS ( content management system ) Google Ads SEO, SEM, CRM ... and incorporate learnings to drive continuous improvements + Create promotional and content strategies to expand digital reach + Collaborate on developing content… more
- Humana (Albany, NY)
- …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...other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some… more
- CVS Health (Albany, NY)
- …researching and resolving Medicare complaints received via the Centers for Medicaid and Medicare Services ( CMS ). In this role, you will manage a queue of ... Medicare knowledge/experience + Prior experience with complaints and/or Center for Medicare and Medicaid Services ( CMS ) + Medical/RX claim processing… more
- Humana (Albany, NY)
- …team to assist and facilitate new hires and remediation of medical directors performing Medicare utilization management processes and be the liaison for the ... key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with...or nurse, with a focus on our 5+ million Medicare members. You will also facilitate the delivery of… more
- Centers Plan for Healthy Living (Brooklyn, NY)
- …by explaining program benefits in a manner that is compliant with Center for Medicare and Medicaid Services ( CMS ) and company policies and regulations. The ... need for healthy living. JOB SUMMARY : The Licensed Benefits Advisor- Medicare Sales, Maintains relationships, services our existing customers and secures new… more