- Centene Corporation (New York, NY)
- …activities. + Performs medical review activities pertaining to utilization review, quality assurance , and medical review of complex, controversial, or ... Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions...to providers that would improve utilization and health care quality . + Reviews claims involving complex, controversial,… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …activities. Performs medical review activities pertaining to utilization review, quality assurance , and medical review of complex, controversial, ... assists the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.… more
- Centene Corporation (New York, NY)
- …activities. + Perform medical review activities pertaining to utilization review, quality assurance , and medical review of complex, controversial, or ... cost-effectiveness of care and service for members. + Provide medical expertise in the operation of approved quality...to providers that would improve utilization and health care quality . + Review claims involving complex, controversial,… more
- Terumo Medical Corporation (Buffalo, NY)
- …Corporation (TMC) develops, manufactures, and markets a complete, solutions-based portfolio of high- quality medical devices used in a broad range of applications ... Req ID: 5000 Location: Buffalo, NY, US Company: Terumo Medical Corporation Department: TIS Sales - Allegheny Plateau Terumo...complaints (ie adverse events, product performance reports, etc.) to Quality Assurance (QA), and by ensuring all… more
- Terumo Medical Corporation (Queens, NY)
- …Corporation (TMC) develops, manufactures, and markets a complete, solutions-based portfolio of high- quality medical devices used in a broad range of applications ... Req ID: 4615 Location: Queens, NY, US Company: Terumo Medical Corporation Department: TIS Sales - New York Metro...complaints (ie adverse events, product performance reports, etc.) to Quality Assurance (QA), and by ensuring all… more
- Elevance Health (Latham, NY)
- …in applicable state(s). + Requires a minimum of 10 years of experience in claims auditing, quality assurance , or clinical documentation improvement, and a ... experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing… more
- Sedgwick (Albany, NY)
- …RESPONSIBILITIES** + Performs other duties as assigned. + When not in the field, assist quality assurance team and be available for desk appraisal work as well ... with information regarding their vehicle's cost of repair estimate and explains claims /repair process + Maintains accurate vehicle's cost of repair estimate and… more
- Intermountain Health (Albany, NY)
- …regulatory guidelines and established departmental policies and procedures, objectives, quality assurance program, safety, environmental and infection control ... Requirements + Workflow Process + Communication + Insurance Processing and Issues + Medical Terminology + Claims Processing + Collaboration + Time Management +… more
- New York eHealth Collaborative (New York, NY)
- …external stakeholders. + Design, implement, maintain, and enhance data workflows, quality assurance protocols, analytical processes, and reporting products (eg, ... (eg, R, SAS, SQL, Python, Salient) as well as quality assurance processes. + Hands-on experience with...both technical and non-technical audiences. + Familiarity with Clinical Quality reporting, Medicare and Medicaid claims data,… more
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- …fax, mail, and upload correspondence and documentation as needed. + Follow established quality assurance standards and all policies and procedures. + Report and ... About The Role MagnaCare provides Utilization Review/ Case Management/ Medical Management/ Claims Review services to its clients. Care Coordinators facilitate… more
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