- Excellus BlueCross BlueShield (Rochester, NY)
- …II (in addition to Level I Qualifications) + Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge of ... case reviews and may require peer-to-peer discussions with providers regarding UM case review determinations. + Provides clinical expertise on ARD cases,… more
- Humana (Albany, NY)
- …team and healthcare organization. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, ... quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will...with Case managers or Care managers on complex case management, including familiarity with social… more
- CenterWell (Albany, NY)
- …knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review ... and use of business metrics. + Experience working with Casemanagersor Caremanagerson complex case management, including familiarity with social determinants of… more
- Humana (Albany, NY)
- …knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review ... group practice management. + Utilization management experience in a medical management review organization, such as Medicare...with Case managers or Care managers on complex case management, including familiarity with social… more
- Humana (Albany, NY)
- …knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review ... group practice management. + Utilization management experience in a medical management review organization, such as Medicare...with Case managers or Care managers on complex case management, including familiarity with social… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …federal regulatory mandates related to the Health Plan Essential Accountabilities: Level I + Review / prep clinical case for clinical staff. + Navigates and ... statistics on a daily and as needed basis for department related metrics: case and review timeliness, workflow volumes, referrals generated to care management… more
- Datavant (Albany, NY)
- …rising to the challenge of tackling some of healthcare's most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, ... attention to detail and a depth of knowledge in medical terminology. This role is fully remote with a...facility. + Experience with significant level of coding quality review feedback + Experience in computerized encoding and abstracting… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- … review activities pertaining to utilization review , quality assurance, and medical review of complex , controversial, or experimental medical ... general psychiatry and/or addiction disorders. + Ability to identify, analyze and resolve complex medical issues. + Skills in evidence-based medicine. + Strong… more
- Datavant (Buffalo, NY)
- …rising to the challenge of tackling some of healthcare's most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, ... or responsibilities as evident or required. + Consistent application of medical privacy regulations to guard against unauthorized disclosure. + Responsible for… more
- City of New York (New York, NY)
- …that students are healthy and ready to learn. Physicians in OSH also review medical accommodations, respond to public health emergencies, and coordinate with ... to support the health and safety of students. Role Overview: CMS II (Assistant Medical Director of High Schools) High school students represent one of the most… more