- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting ... residence + Eligibility to participate in federal prescription programs (eg, Medicare /Medicaid) + Self-directed with the ability to work effectively both… more
- Ellis Medicine (Schenectady, NY)
- …experience in a hospital environment preferred. + Previous case management, utilization review , and discharge planning experience highly preferred. Home care, ... Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration with physicians and...+ Adheres to the New York State Department of Health and Centers for Medicare and Medicaid… more
- Molina Healthcare (Albany, NY)
- … Medicare . **PREFERRED EDUCATION:** Master's in Business Administration, Public Health , Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review ... medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred… more
- CenterWell (Albany, NY)
- …being highly knowledgeable regarding post-acute levels of care, and an expert regarding CenterWell Home Health services including home health , hospice, ... care. The Clinical Care Coordinator is expected to communicate with the CenterWell Home Health clinical team and help facilitate timely patient follow-up for… more
- Fresenius Medical Center (Centereach, NY)
- …all regulatory and FMS policy requirements. Functions as part of the hemodialysis health care team in providing safe and effective dialysis therapy for patients ... manner. **PRINCIPAL RESPONSIBILITIES AND DUTIES** PATIENT CARE: + Assist other health care members in providing patient specific detailed education regarding… more
- Stony Brook University (Stony Brook, NY)
- …physical examination and obtain medical clearance from the Long Island State Veterans Home Employee Health Department. + Complete electronic reference check with ... Assessor **Position Summary:** At the Long Island State Veterans Home , the MDS Assessor is a value member of...the Department of Veteran's Affairs. + Completes notification to Medicare beneficiaries for changes in level of care (SNF… more
- Humana (Albany, NY)
- …provider relations, claims submission and payment, utilization management processes, behavioral health processes, and dispute resolution. **Work at Home ... part of our caring community and help us put health first** Humana Healthy Horizons is seeking a Medicaid...timelines. + Submits required documents to state agencies for review and approval. + Regularly meet with Humana Healthy… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** Humana Healthy Horizons is seeking a Provider Support Model Lead, Provider Engagement to ... at least two of which are working for a health plan. + 5+ years HEDIS and quality measures...5+ years HEDIS and quality measures and ability to review and interpret cost and quality data to drive… more
- CenterWell (Albany, NY)
- …Experience a plus + Current nursing experience in Hospital, SNF, LTAC, DME or Home Health . + Bilingual We offer tangible and intangible benefits such as ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy… more
- Evolent (Albany, NY)
- …and vendor contracting, compliance, population health (including utilization management), Medicare , and Medicaid. + Draft, review and negotiate contracts ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...President, Deputy General Counsel, the Attorney will prepare and review a variety of complex contracts and provide legal… more