• Medical Director - Florida

    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...conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and… more
    Humana (07/29/25)
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  • Medical Director - South Central

    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 ... to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of...conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and… more
    Humana (07/11/25)
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  • Medical Director , Commercial Line…

    Excellus BlueCross BlueShield (Rochester, NY)
    …Functions as a mentor and resource throughout the workday in training medical director colleagues, as needed. + Conduct clinical appeal case reviews and may ... you, we encourage you to apply! Job Description: The Medical Director participates in the broad array... expertise on ARD cases, Quality of Care cases, clinical editing, coding reviews and inquiries. +… more
    Excellus BlueCross BlueShield (07/01/25)
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  • Director , Prospective + Concurrent Risk…

    Datavant (Albany, NY)
    …to deliver complex healthcare technology solutions. + Solid understanding of clinical suspecting, concurrent coding workflows, risk adjustment models (eg, ... requirements, medical record standards, and regulatory guidance impacting concurrent coding or risk adjustment. + Product experience integrating into EHRs or… more
    Datavant (08/08/25)
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  • Associate Medical Director , PVRM

    Sumitomo Pharma (Albany, NY)
    …seeking a dynamic, highly motivated, and experienced individual for the position of **Associate Medical Director .** The Associate Medical Director will ... Serious Adverse Event Reports (SAEs), and Product Complaints (PCs) + Contributes to medical safety of clinical trials, including monitoring of clinical more
    Sumitomo Pharma (08/02/25)
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  • Medical Director - Spine

    CVS Health (New York, NY)
    …anywhere in the US.** Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Spine) that can be remote based, work from home. The ... Medical Director (Spine) will be a Subject...for predetermination reviews ad reviews of claim determinations, providing clinical , coding , and reimbursement expertise, using multiple… more
    CVS Health (08/08/25)
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  • Director , Registered Nurse/Certified Risk…

    Ankura (New York, NY)
    clinical care, clinical documentation, compliance, or coding of medical services + Medical coding certification (will consider non-coders with an ... investigations through the evaluation of medical records, the determination of medical necessity and appropriate medical coding , and the computation… more
    Ankura (07/22/25)
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  • Clinical Reimbursement Manager; HSO Drg…

    Mount Sinai Health System (New York, NY)
    …requirements. The CRM works in conjunction with the Associate Director and Director of DRG Validation to help develop coding education and training and ... the attending physician's description and the information contained in the beneficiary's medical record. Responsible for performing quality reviews of medical more
    Mount Sinai Health System (07/17/25)
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  • Dental Director

    Anthony Jordan Health Corp (Rochester, NY)
    DENTAL DIRECTOR ROCHESTER, NY (http://maps.google.com/maps?q=82+Holland+St+ROCHESTER+NY+USA+14605) * Dental Apply Job Type Full-time Description The health services ... to health and health care, meeting their need for comprehensive medical , dentistry, behavioral health, and community services. Starting in northeast Rochester,… more
    Anthony Jordan Health Corp (06/11/25)
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  • Dialysis Clinical Manager Registered Nurse…

    Fresenius Medical Center (Jamaica, NY)
    …+ Facilitates the application process for physician privileges and compliance with FMS Medical Staff By-Laws. + Responsible for strong Director and physician ... requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory… more
    Fresenius Medical Center (07/17/25)
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