- Molina Healthcare (Rochester, NY)
- …including 2 years in a manager role. * Experience reviewing all types of medical claims (eg CMS 1500, Outpatient/Inpatient, Universal Claims , Surgery, ... processed in accordance with local Health Plan requirements * Works with Claims , Configuration, Contracting, Provider Data Management , and other business… more
- MTA (Brooklyn, NY)
- …TA/OA Department: Law Division/Unit: Torts Reports to: Assistant General Counsel / Director of Claims Work Location: 130 Livingston Street, Brooklyn Hours ... aid defense counsel; reviewing and drafting reports for senior management ; serving as liaison between the torts department and...damage claims brought against MTA agencies. Review claims and relevant factual and medical records… more
- Amentum (Albany, NY)
- …appropriate insurance coverage and risk mitigation strategies. + Lead complex claims management , including litigation strategy and resolution in coordination ... **Amentum seeks a Director , Insurance and Risk Management .** **Amentum**...sectors.** + Deep knowledge of insurance products, risk financing, claims management , and enterprise risk practices. +… more
- Otsuka America Pharmaceutical Inc. (Albany, NY)
- …medicines for those with CNS disorders, we are seeking a skilled and experienced Medical Director of CNS Early Assets, Global Medical Affairs, responsible ... , Franchise Lead CNS Early Assets. **Position Summary:** The Medical Director , Global Medical Affairs,...for any assigned assets in development. + Support lifecycle management initiatives and planning for assigned assets as applicable.… more
- Humana (Albany, NY)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
- Otsuka America Pharmaceutical Inc. (Albany, NY)
- **Job Summary** The Associate Director (AD), Commercial Data Management (CDM) within Data Enablement (DE) for Business Analysis (BA) is accountable for ... and utility of Otsuka's data assets. **Job Description** Reporting to the Director CDM, this role will be responsible for providing strategic insight and… more
- Humana (Albany, NY)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
- Centene Corporation (New York, NY)
- …the Chief Medical Director to direct and coordinate the medical management , quality improvement and credentialing functions for the business unit. + ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a...performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- … Management /Utilization Management (QM/UM) Plan, including having the BH Medical Director for Children's Services and participate on the BH committees ... of the Children's Behavioral Health (BH) Carve-In program. The Medical Director for BH Children's Services has...claims and appeals and resolves grievances related to medical quality of care, as needed. + Ensures that… more
- Humana (Albany, NY)
- …put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate ... Medical Director works on problems of diverse scope and complexity...focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with… more