- Elevance Health (New York, NY)
- …+ Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation. + Determine medical ... **Clinical Operations Medical Director ** **Carelon MBM** **Virtual:** This...CMS Coverage Determinations, as applicable. + Perform physician-level case review of utilization requests for procedures and interventions listed… more
- Humana (Albany, NY)
- …how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of moderately complex to complex ... caring community and help us put health first** The Medical Director relies on medical ...group practice management. + Utilization management experience in a medical management review organization, such as Medicare… more
- Humana (Albany, NY)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex ... caring community and help us put health first** The Medical Director actively uses their medical...group practice management. + Utilization management experience in a medical management review organization, such as Medicare… more
- Humana (Albany, NY)
- …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...and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation… more
- Health Advocates Network (Albany, NY)
- …Reviewer Quality Assurance assignments and assisting with package reports for submission to Medical Director for review + Participating in administrative ... personnel, and fiscal services. **PREFERRED QUALIFICATIONS:** - Experience with the medical conduct process. - Experience with the Statewide Financial System (SFS).… more
- Datrose (Albany, NY)
- …Reviewer Quality Assurance assignments and assisting with package reports for submission to Medical Director for review Participating in administrative unit ... Law requests, including researching and drafting responses for OPMC Director approval, and tracking assignments Coordinating Executive Correspondence for OPMC… more
- Knowledge Builders Inc. (Albany, NY)
- …Reviewer Quality Assurance assignments and assisting with package reports for submission to Medical Director for review . - Participating in administrative ... personnel, and fiscal services. PREFERRED QUALIFICATIONS: - Experience with the medical conduct process. - Experience with the Statewide Financial System (SFS).… more
- Centene Corporation (New York, NY)
- …and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …external standards set by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with ... identifies and refers potential quality of care and utilization issues to Medical Director . + Utilizes appropriate communication techniques with members and… more
- Elmcrest Children's Center (Syracuse, NY)
- …consultation and interventions at the discretion and under the supervision of the Medical Director . + Review sub-specialty consultations and medical ... a week, with early evening hours. The Nurse Practitioner works closely with the Medical Director to best provide medical services to the children of Elmcrest… more