- Molina Healthcare (Yonkers, NY)
- …for both internal staff and vendor oversight. + Experience working within a Managed Care Organization (MCO) or health plan environment. + Proven ability to manage ... complex vendor relationships and recovery strategies (eg, first-pass and second-pass vendor models). + Strong understanding of federal and state regulations related to subrogation, including HIPAA, Medicaid TPL requirements, and CMS guidelines. + Excellent… more
- Rochester Regional Health (Rochester, NY)
- …Flexibility and ability to work as a team player. + Understanding of managed care, formularies, and payer policies. + Experience with Electronic Health Records (EHR) ... systems. EDUCATION: LICENSES / CERTIFICATIONS: PHYSICAL REQUIREMENTS: M - Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move… more
- AbbVie (New York, NY)
- …pharmaceutical industry experiences such as physician/account-based selling, training, managed health care or marketing preferred. English language proficiency ... verbally and in writing (for all non-English speaking countries). + An essential requirement of your position is to satisfy all applicable health care industry representative (HCIR) credentialing requirements to gain and maintain entry into facilities and… more
- East House Corporation (Rochester, NY)
- …meal preparation, and maintaining a safe and sanitary environment. Safely Managed Medications: o Provide supervision to clients in managing their medications. ... o Adhere to East House medication policies and procedures. Documentation Standards: o Maintain documentation to the standards defined by regulators, funders, and East House policies and procedures. Results/Measures: . Achievement of client goals as identified… more
- New York State Civil Service (New York, NY)
- …Health Department on matters of joint concern, including those impacting Managed Care Organizations and Continuing Care Retirement Communities;* Supervises the ... analysis and comments on proposed amendments to laws affecting companies under the Health Business Unit's jurisdiction;* Supervises the drafting of proposed new regulations, circular letters, and law amendments;* Coordinates and oversees the processing of rate… more
- Caz Recovery (Eden, NY)
- …and medical staff members in advocating for residents during Medicaid managed care and insurance company reviews. + Accurately completes medical documentation ... for each resident. + Provides basic First Aid and CPR when necessary and maintains current certifications. Requirements + One year's experience practicing as a Licensed Practical Nurse. + Requires an unrestricted New York State License or Certification:… more
- Staffing Solutions Organization (Albany, NY)
- …Public Consulting Group LLC (PCG), is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed to a diverse ... workforce, which is a reflection of our clients and the people they serve. **Senior Healthcare Program Specialist (Level 2 or 3) - Albany, NY** **Division of Eligibility & Marketplace Integration (DEMI)** **Bureau of Third-Party Health Insurance, Medicare… more
- New York Botanical Garden (Bronx, NY)
- …when they occur. + Must be able to physically participate in the work being managed , including the ability to move 25 lbs. and lift overhead. + Knowledge of safety ... codes. + Driver's license required. Class B license preferred. + Must be available for 24-hour on-call duty, including weekends, holidays, and emergency response situations. Physical Demands & Work Environment: While performing the duties of this position, the… more
- Catholic Health Services (Bethpage, NY)
- …ensures all required pre-certifications/authorizations are obtained and on file per Managed Care guidelines. Responsible for conducting pre-admit and/or day of ... testing patient interviews to ensure complete and accurate demographics and insurance information are entered into the Hospital Information System as well as scheduling in EPIC. Responsible for ordering tests and procedures in Cadence and Radiant. Communicates… more
- Trinity Health (Syracuse, NY)
- …distributesappropriate correspondence. Ensures that all expirables are reviewed, obtained and managed on a monthlybasis according to the rules and policies. Assists ... in managing the flow of information between the MSO team,Credentials and MEC Committee members, Medical Staff Leadership(including the Service, Department and Section Chairpersons) and theVice President for Medical Affairs. Assists Medical Staff Services… more