- Humana (Albany, NY)
- …a part of our caring community 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 interpretation and determinations whether services provided… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Non-Certified Medical AssistantDepartment: Cardiology Location: Potsdam, NY Hours Per Week: 40 scheduled weekly hoursSchedule: 8 hour shift, Mon-Friday, ... 7:30a-4:00p SUMMARY: The Medical Assistant performs a...signs to acknowledge documentation is accurate as required by federal /state and CMS regulations and DNV certification. Provide effective… more
- Glens Falls Hospital (Glens Falls, NY)
- …financial analytics requiring broad experience, skill and knowledge of Albany Medical Center * Collaborates with multiple departments and provides high-level project ... of computer-based applications and strong PC/ keyboard skills. * Knowledge of medical terminology. * Strong attention to detail and demonstrated ability to use… more
- Humana (Albany, NY)
- …our caring community and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. The ... Behavioral Health Medical Director work assignments involve moderately complex to complex...additional license, if required + No current sanction from Federal or State Governmental organizations, and able to pass… more
- Humana (Albany, NY)
- …a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and… more
- CVS Health (Albany, NY)
- …or Internal Medicine / Pediatrics (Med / Peds) Board Certification. In the Medical Director role, you will provide oversight for medical policy implementation. ... and consistent responses to members and providers. As a Medical Director you will focus primarily on review appeal...will be considered for employment in accordance with all federal , state and local laws. We are an equal… more
- CVS Health (New York, NY)
- …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 ... including post-graduate direct patient care experience specifically. Expands Aetna's medical management programs to address member needs across the continuum… more
- Highmark Health (Albany, NY)
- …current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and ... RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to...includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well… more
- 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 ... situations or data requires an in-depth evaluation of variable factors. The Medical Director provides medical interpretation and decisions about the… more
- Mount Sinai Health System (New York, NY)
- **Job Description** Controls the release of health information from patient medical records in accordance with regulatory requirements, hospital policies and ... procedures and federal and state statutes. Responsible for ensuring compliance with...related health care field is preferred. + Knowledge in medical terminology, basic anatomy and physiology, medico-legal and regulatory… more