- Molina Healthcare (Buffalo, NY)
- …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... second level BH clinical reviews, BH peer reviews and appeals * Supports BH committees for quality compliance. *...Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review, medical … more
- Evolent (Albany, NY)
- …recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... request and provides clinical rationale for standard and expedited appeals . + Utilizes medical /clinical review guidelines and...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Molina Healthcare (Yonkers, NY)
- …reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * ... JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and ...* Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for… more
- Molina Healthcare (Syracuse, NY)
- …reviews behavioral health portions of state contracts. * Assists behavioral health medical director lead trainers in the development of enterprise-wide education ... JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health...second level behavioral health clinical reviews, peer reviews and appeals . * Supports behavioral health committees for quality compliance.… more
- Catholic Health Services (West Islip, NY)
- …limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals , Managed Care and Revenue Cycle and Patient Access departments to ensure ... Overview The Director of Care Management is responsible for providing...Provides guidance and education to the Care Coordination department, Medical Staff, and SCSH Administrative Staff. + Ensures compliance… more
- Baylor Scott & White Health (Albany, NY)
- …dashboards and reports for senior leadership, hospital senior leadership, and senior medical staff including denials from all payers, Medicare /Medicaid audit ... **Job Summary** The Director , Denial Resource Center is responsible for the...improved utilization of appropriate patient care services. Collaborates with medical , clinical, HIM and other BSWH departments to ensure… more
- Access: Supports For Living (Middletown, NY)
- Revenue Cycle Director Location: Middletown, NY, United StatesDate Posted: Nov 26, 2025 Share: share to e-mail Apply Now Save JobSaved Description ... of behavioral health billing in New York State, particularly regarding Medicare , Medicaid, Medicaid Managed Care, and Commercial Insurance. Key Responsibilities +… more
- Cognizant (Albany, NY)
- …. Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... the Health Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing medical necessity denials for resolution. You will be a valued member… more
- MVP Health Care (Rochester, NY)
- …care. + The Case Manager will also monitor and review cases with the Medical Director to ensure appropriate outcomes. + Service Authorization & Review: Conduct ... reporting. + Cost Management: Monitor service utilization to maintain cost-effectiveness and manage Medical Loss Ratio (MLR). + Appeals & Denials: Participate in… more
- Buffalo Hearing & Speech Center (Buffalo, NY)
- …billing as assigned individually by the accounts receivable manager. Experience in Medicare and Medicaid HMO's, Commercial payers such as ChampVA, Tricare, UHC, ... up is to be done bi-monthly on assigned controls to include corrected claims, appeals , phone calls, or provider rep assistance to assure any missing or incorrect… more