- Humana (Albany, NY)
- …a part of our caring community and help us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D ... & B). The Medical director work assignments involve moderately complex to complex...where the analysis of situations or data requires a case -by- case consideration of the Medicare rules, Humana… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …and implementation of the Children's Behavioral Health (BH) Carve-In program. The Medical Director for BH Children's Services has overall accountability for BH ... Health Carve-In program following NYS directives and guidelines. + Completes medical necessity reviews and peer-to-peer calls in timely manner and provides… more
- Actalent (Newburgh, NY)
- …rooms. Additionally, the role requires assisting physicians with procedures by documenting medical history and case notes, relaying instructions from the ... for examination/procedures. + Assist physicians with procedures and document medical history and case notes + Relay...Europe, Actalent serves many of the Fortune 500. The company is an equal opportunity employer and will consider… more
- Elevance Health (New York, NY)
- …external entities and/or serve on internal and/or external committees. + May chair company committees. + Interprets medical policies and clinical guidelines. + ... ** Medical Director** _Please note that per our policy...and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers… more
- CVS Health (New York, NY)
- …a remote based (work at home) based anywhere in the US.** Aetna, a CVS Health Company , has an exciting opportunity for a Medical Director (Spine) that can be ... **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** . + **No-cost programs… more
- CVS Health (Albany, NY)
- …**Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** . + **No-cost programs ... transforming health care. As the nation's leading health solutions company , we reach millions of Americans through our local...serve as the first point of contact for complex case issues or challenges. + Support hiring, onboarding, and… more
- Travelers Insurance Company (Melville, NY)
- …with insured based on application of policy information to facts or allegations of each case . + Consults with Manager on use of Claim Coverage Counsel as needed. + ... such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of… more
- Sedgwick (Albany, NY)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Sr VP Medical Director (Hourly) The ideal candidate would work 8-20 hours per week. **PRIMARY ... PURPOSE** **:** To evaluate medical reports escalated due to deficient information utilizing evidence...+ Coordinating and evaluating the service delivery between the company , partners, and vendors. + Member of a client… more
- Humana (Albany, NY)
- …and experience with national guidelines such as NCD/LCD, MCG(R) or InterQual The Medical Director conducts clinical case reviews of requests received by members ... 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… more
- Cordis (New York, NY)
- …scientific and medical information between KOLs, other investigators and the company 's Medical Affairs, Marketing and R&D groups. + Propose strategic ... SFA, and Peripheral BTK), Cordis is leading the way in delivering transformative medical solutions. At Cordis, we're teammates, not just employees. We embrace an… more