- Rochester Regional Health (Rochester, NY)
- …potential inpatient medical necessity denials. Review patient class in the event manager , assist with LOC determination retrospectively, and changes patient class as ... members in clinical problem solving. REQUIRED QUALIFICATIONS: + 3 years of acute hospital care, Case Management and/or...degree + Knowledge of Federal and State regulations (DOH, Medicaid /Medicare) + Knowledge of third party payer and/or managed… more
- Centers Plan for Healthy Living (New York, NY)
- …selling/marketing and performing all required tasks assigned by the Sales Manager . Incumbent will be responsible for educating and enrolling potential beneficiaries ... by explaining program benefits in a manner that is compliant with...manner that is compliant with Center for Medicare and Medicaid Services (CMS) and company policies and regulations. The… more
- Catholic Health Services (Melville, NY)
- …Health Physician Advisors. Prepares and leads monthly Physician Advisor meeting. 3 . Training and Education Responsible for hiring and managing Physician Advisors, ... along with developing and monitoring compliance with an educational program . Collaborates with management in recruiting new Catholic Health Physician Advisor hires.… more
- City of New York (New York, NY)
- …A 6.1.9 TITLE CHANGE The HIV/AIDS Services Administration (HASA) is the most comprehensive program of its kind in the country, helping New Yorkers living with HIV or ... housing, and assistance with applying for public benefits and services including Medicaid , food stamps and cash assistance. HASA also provides vocational services… more
- City of New York (New York, NY)
- …- Train, coordinate, and supervise the SCU nursing staff to meet OCFH program objectives. - Supervise and participate in scheduling nursing visits to skilled nursing ... facilities. - Participate in review and collect medical documentation for non- Medicaid reimbursable requests. - Examine various requests, forms, and other… more
- City of New York (New York, NY)
- …representation of the Agency at NYS Administrative Hearings in the following program areas: Cash Assistance (CA), Supplemental Nutrition Assistance Program ... - Process extension of Medical coverage for clients entitled to AC and whose Medicaid eligibility is scheduled to expire or has already expired. Process "clock down"… more
- Evolent (Albany, NY)
- …+ Not under current exclusion or sanction by any state or federal health care program , including Medicare or Medicaid , and is not identified as an "excluded ... Responsible for coordinating education and findings with matrixed Physician Business Manager . + Provides medical direction to the support services review process.… more
- City of New York (New York, NY)
- …representation of the Agency at NYS Administrative Hearings in the following program areas: Cash Assistance (CA), Supplemental Nutrition Assistance Program ... Process extension of Medical coverage for clients entitled to AC and whose Medicaid eligibility is scheduled to expire or has already expired. Processes "clock down"… more
- CenterWell (Albany, NY)
- …+ Previous experience with pharmacy benefits management + Previous Commercial, Medicare and/or Medicaid experience + 3 or more years clinical experience in ... members + Previous management experience and ability to lead teams + Previous program or project management experience + Proven success in leading teams (both direct… more
- Albany Medical Center (Albany, NY)
- …stays on top of national and local payer trends. + Planning and Program Development and Oversight + Identifies, facilitates, and builds systems and standardized ... experience in an insurance or health care setting - required + three ( 3 ) years of experience managing departmental resources including people - required + Five… more