- Healthfirst (NY)
- …when case load volume fluxes and when Leadership requests changes in case priorities to support our members//internal medical departments as needed + ... **Duties//Responsibilities:** + The Medical Peer Reviewer will assess//review requests for authorization,...thinking, communication, and problem-solving skills + Knowledge of UM/QM case philosophies and reporting requirements to state and federal… 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...participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post-acute… 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 ... of situations or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …compliance and regulatory requirements. Primary activities include substantiating referrals, case planning and research, conducting onsite or desk audits, clinical ... reviews of medical records to ensure correct billing of services and...flags/aberrant billing patterns. + Manages cases as assigned, prioritizing case load as appropriate. Maintains case logs,… more
- City of New York (New York, NY)
- …services, public health initiatives, chronic disease management, reproductive health care, and case management to ensure that students are healthy and ready to ... learn. Physicians in OSH also review medical accommodations, respond to public health emergencies, and coordinate with community providers to support the health and… more
- University of Rochester (Rochester, NY)
- …overbooking and rearranging of surgeons Operating Room schedules based on case complexity and medical urgency. Authorizes rescheduling when cancellations ... lectures and speaking engagements for the provider. - Researches hospital medical records for information requested by physicians, insurance companies and attorneys.… more
- SUNY Upstate Medical University (Syracuse, NY)
- …Psychology or Behavior Analyst) will provide clinical services, clinical supervision and case management for inpatient cases as specified by the Program Director; ... Health Inpatient Unit. . Provide direct clinical services, clinical supervision and case management of patients including but not limited to: behavior treatment… more
- Elevance Health (New York, NY)
- … medical necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director review or policy ... **Clinical Operations Associate Medical Director** **Carelon Medical Benefit Management**...make an impact: + Ensures timely completion of clinical case reviews for their board certified specialty. + Makes… more
- Molina Healthcare (Yonkers, NY)
- JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting ... and cost-effective member care. Essential Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports… more
- CenterWell (Albany, NY)
- **Become a part of our caring community and help us put health first** The Medical Director, Primary Care relies on medical background and reviews health claims. ... of situations or data requires an in-depth evaluation of variable factors. The Medical Director relies on medical background and reviews health claims. The… more