• AVP, Encounters

    Molina Healthcare (Syracuse, NY)
    …oversight of processes that track, evaluate, and submit encounter deletions for Medicare Advantage, ACA, and Medicaid lines of business. This role has ... decision-making accountability for ensuring compliance with complex regulatory requirements, protecting the integrity of...experience in related job. + 2 years minimum in Director level role or above. + Extensive understanding of… more
    Molina Healthcare (08/22/25)
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  • Utilization Management Reviewer, RN (Multiple…

    Excellus BlueCross BlueShield (Rochester, NY)
    …of physical health (PH) medical and healthcare services for members, ensuring compliance with internal and external standards set by regulatory and accreditation ... entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case Management to address member needs. Participates in… more
    Excellus BlueCross BlueShield (10/07/25)
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  • Manager, Credentialing

    University of Rochester (Albany, NY)
    …of practitioners and patient safety of the facility. Supervises ongoing compliance monitoring. Recruits, hires, supervises and manages the performance of department ... organizational policies. + Ensures the Medical Staff Services department is in compliance with regulatory standards, including but not limited to, The Joint… more
    University of Rochester (08/25/25)
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  • Research Scientist 4 - Institutional Review Board…

    New York State Civil Service (Staten Island, NY)
    …10314 Duties Description Job Description: Under the direct supervision of the IBR Deputy Director and Director of Research and reporting to the Chief Research ... Compliance Officer (CRCO) at Nathan Kline Institute (NKI)/OMH, along...maintain eligibility for full and unconditional participation in the Medicare and Medicaid programs. Continued employment will depend on… more
    New York State Civil Service (10/05/25)
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  • Supervisor Veterans Home Fiscal Administration (NY…

    New York State Civil Service (Jamaica, NY)
    …NYS Veterans Home at St. Albans. The position reports to the Fiscal Director of the Health Facilities Management Group. The position also reports to Administrator ... projections, capital outlay and fixed assets schedules, and Medicaid & Medicare reimbursement activities for the facility.* Develops, implements, reviews, and… more
    New York State Civil Service (10/10/25)
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  • Admissions & Infection Control RN Coordinator

    Guthrie (Cortland, NY)
    …clinical and financial information under the discretion of the Administrator and Director of Nursing. This will include, but not be limited to pre-admission ... illness and disability. + Preferred knowledge of MDS, PRI/Screen instruments, Medicare , and Medicaid. Essential Functions: Coordinates admissions of residents: +… more
    Guthrie (09/19/25)
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  • Assistant Site Supervisor , Bureau of Equitable…

    City of New York (New York, NY)
    …Engagement Unit, Health and Hospitals, and Community-based Organizations. To ensure full compliance of these partnerships the Bureau of Equitable Health Systems is ... 65 or older, Blind and Disabled (ABD) Medicaid and Medicare Savings program (MSP); applying for Medicare ;...the job application or interview process, contact Sye-Eun Ahn, Director of the Office of Equal Employment Opportunity, at… more
    City of New York (08/13/25)
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  • Licensed Psychologist

    New York State Civil Service (Albany, NY)
    …clinical reviews, recommendations, and determinations in collaboration with the Medical Director 's office, maintaining compliance with all bureau, agency, ... (Clinical Quality Assurance Team Lead) will report directly to the Bureau Director . This position will implement standard operating procedures which will be the… more
    New York State Civil Service (10/04/25)
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  • Transplant Data Coordinator

    WMCHealth (Valhalla, NY)
    …Job Details: Job Summary: The Transplant Data Coordinator works closely with the Director for Data Compliance and is responsible for obtaining, tracking, and ... with all reporting requirements specified by Centers for Medicare and Medicaid Services (CMS), United Network for Organ...system for patient management and research purposes. + Assist Director of Data Compliance in preparation and… more
    WMCHealth (10/09/25)
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  • LPN

    WMCHealth (Margaretville, NY)
    …that govern Mountainside Residential Care Center, and as may be required by the Director of Nursing Services or Nurse Supervisor to ensure that the highest degree of ... all times. Responsibilities + Administrative functions: + Notifies the RN on-call, Director of Nursing, and Administrator on call as required. + Participates… more
    WMCHealth (09/12/25)
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