- Molina Healthcare (Albany, NY)
- …Administration, Public Health, Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review , medical policy/procedure development, provider ... Summary** Responsible for serving as the primary liaison between administration and medical staff . Assures the ongoing development and implementation of policies… more
- CVS Health (Albany, NY)
- …medical director to be part of a centralized team that supports the Medical Management staff ensuring timely and consistent responses to members and providers ... related to precertification, concurrent review , and appeal request. The medical director...peer coverage of denials. * Appeals - The medical director will perform appeals in their "base plan"… more
- Molina Healthcare (Syracuse, NY)
- …* Experience with utilization/quality program management. * Managed care experience. * Peer review experience. * Certified Professional in Healthcare Management ... * Implements behavioral health specific clinical practice guidelines and medical necessity review criteria. * Tracks all...national, state, and local laws and regulatory requirements affecting medical and clinical staff . * Ability to… more
- Fresenius Medical Center (Mineola, NY)
- …+ Facilitates the application process for physician privileges and compliance with Fresenius Medical Care Medical Staff By-Laws. + Responsible for strong ... **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations.… more
- Mount Sinai Health System (New York, NY)
- …(FPPE) or the Ongoing Professional Practice Proctoring Evaluation (OPPE) as required by Medical Staff for continued credentialing status. + Practices as a member ... according to the rules and regulations of the Medical Staff and the bylaws of the...nurses and other health team members. + Participates in peer review . + Incorporates research findings in… more
- Mount Sinai Health System (New York, NY)
- …(FPPE) or the Ongoing Professional Practice Proctoring Evaluation (OPPE) as required by Medical Staff for continued credentialing status. 13. Practices as a ... according to the rules and regulations of the Medical Staff and the bylaws of the...nurses and other health team members. 6. Participates in peer review . 7. Incorporates research findings in… more
- Mohawk Valley Health System (Utica, NY)
- …of care advisement. + Support education to minimize clinical variability throughout the medical staff . + Assist case managers with Medicare and Medicaid appeals ... reimbursement models in decision making and reviews. + Provide peer -to- peer payor review in collaboration...liaison between the CDI professional, HIM, and the hospital's medical staff to facilitate accurate and complete… more
- Molina Healthcare (Yonkers, NY)
- …* Experience with utilization/quality program management. * Managed care experience. * Peer review experience. * Certified Professional in Healthcare Management ... of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff . * Ability to work cross-collaboratively within… more
- Albany Medical Center (Albany, NY)
- …SAFE/SANE examiners and arrange training classes for SAEs as required. + Oversee peer review of documentation, providing feedback for quality improvement. + ... Conduct quarterly staff meetings for process improvement. + Ensures the proper...newsletter to keep examiners up to date with changes/equipment/case review . + Works with the Medical Director… more
- STG International (West Seneca, NY)
- …safety. * Design and participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health ... STGi is currently seeking a Medical Director to provide services at our Community...and participate in the recruitment, and orientation of clinical staff physicians, physician assistants and nurse practitioners. * Collaborate… more