- CVS Health (Albany, NY)
- …Medicine or Internal Medicine / Pediatrics (Med / Peds) Board Certification. In the Medical Director role, you will provide oversight for medical policy ... and consistent responses to members and providers. As a Medical Director you will focus primarily on...will focus primarily on review appeal cases for denied medical services. This includes First Level Appeals … more
- Humana (Albany, NY)
- … (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the… more
- Molina Healthcare (Rochester, NY)
- …Summary** Responsible for leading, organizing and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance ... * Leads, organizes, and directs the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and...a manager role. * Experience reviewing all types of medical claims (eg CMS 1500, Outpatient/Inpatient, Universal Claims, Surgery,… more
- Molina Healthcare (Yonkers, NY)
- **Job Summary** Responsible for leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for ... etc. * Provides direct oversight, monitoring and training of provider disputes and appeals to ensure adherence with Medicare standards and requirements related… more
- Humana (Albany, NY)
- …Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… 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 ... Medical Director work assignments involve moderately complex to complex issues...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Senior CBO Appeals Analyst position requires an in-depth knowledge of healthcare pricing/reimbursement processes and procedures including ... collaboration with the Underpayment Team manager, the Senior CBO Appeals Analyst will work to further the CBO's goals...meetings. 6. Routinely meets with underpayment team manager and director to provide updates on KPI's. 7. Research and… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Evolent (Albany, NY)
- …business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of the Medical ... including development of questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into the types of cases… 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 ... Medical Director work assignments involve moderately complex to complex issues...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more