- Humana (Albany, NY)
- …Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health ... other healthcare providers, clinical group practice management . + Utilization management experience in a medical management review organization,… more
- Guthrie (Corning, NY)
- …Director and other members of the healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria. b) ... team, the Case Manager will coordinate the flow of services throughout the patient's hospitalization by means of an...care in a cost effective manner and communicating Coordinates medical management through ongoing interaction with the… more
- Centene Corporation (New York, NY)
- …changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national ... Medical Director to direct and coordinate the medical management , quality improvement and credentialing functions... medical review of complex, controversial, or experimental medical services , ensuring timely and quality decision… more
- St. Mary's Healthcare (Amsterdam, NY)
- …coordinates, and oversees the operational functions of the Health Information Management Department to include, acute care, outpatient and ambulatory services ... facility. Responsibilities: + Ensure timely and accurate coding for all healthcare services perform at the organization to include the oversight of coding staff… more
- CVS Health (Albany, NY)
- …Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective ... care management solutions that promote high-quality healthcare for members. We...gather necessary information. + Use established guidelines to authorize services or escalate to Medical Directors as… more
- Centene Corporation (New York, NY)
- …changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national ... medical review of complex, controversial, or experimental medical services . + Support the effective implementation...provider community through the development and implementation of the medical management programs. + As needed, may… more
- Travelers Insurance Company (Albany, NY)
- … capabilities to keep Travelers at the leading edge of the P&C industry. Develop medical management strategies that help injured employees return to work as soon ... **What Is the Opportunity?** Lead the strategy and operations of Travelers Claim Medical initiatives focusing on how developments in the broader medical … more
- Humana (Albany, NY)
- …managed care industry including Medicare Advantage, Managed Medicaid, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health ... background, experience, and judgement to make determinations whether requested services , requested level of care, and/or requested site of...insurance, other healthcare providers. + Utilization management experience in a medical … more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …assists the Chief Medical Director to direct and coordinate the medical management , quality improvement and credentialing functions for the business unit. ... and medical review of complex, controversial, or experimental medical services . Supports effective implementation of performance improvement initiatives… more
- Molina Healthcare (NY)
- …provider reimbursement changes + Provide data driven analytics to Finance, Claims, Medical Management , Network, and other departments to enable critical decision ... Analysis projects related to medical cost reduction initiatives + Support Medical Management by assisting with Return on Investment (ROI) analyses for… more
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