- Elevance Health (Latham, NY)
- …**Carelon Medical Benefits Management** **Post Acute Care Benefit Utilization Management** **Schedule: 10:00-7:00 Central Time** **** **Virtual:** This role ... decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director ...attention, any case review decisions that require Medical Director review or policy interpretation. **Minimum… more
- STG International (Watertown, NY)
- …* Design and participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health enhancement ... STGi is currently seeking a Medical Director to provide services at our Community...Outpatient Clinic. JOB SUMMARY: The general duty of the Medical Director is to provide oversight for the CBOC… more
- STG International (Kingston, NY)
- …+ Design and participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health enhancement ... FOR A FUTURE OPENING STGi is currently seeking a Medical Director to provide services at our Community Based...Outpatient Clinic. JOB SUMMARY: The general duty of the Medical Director is to provide oversight for the CBOC… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- …coordinated care delivery model. Coordinates with the patient care team to review clinic appointment availability utilization to ensure that clinic schedules ... Summary Incumbent serves as an Advanced Medical Support Assistant in the Community Care (CC)...Community Care (CC) Department. Individual works at the VA Medical Center in Albany, New York providing administrative, technical… more
- CVS Health (Albany, NY)
- …Management staff ensuring timely and consistent responses to members and providers. As a Medical Director you will focus primarily on review appeal cases for ... Delivery System eg, Clinical Practice and Health Care Industry. *Prior UM ( Utilization Management) experience *Active and current state medical license without… more
- Humana (Albany, NY)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with health ... health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical … more
- CVS Health (New York, NY)
- …consistent responses to members and providers. Leads all aspects of utilization review /quality assurance, directing case management Provides clinical expertise ... CVS Health Company, has an exciting opportunity for a Medical Director (Spine) that can be remote based, work...that can be remote based, work from home. The Medical Director (Spine) will be a Subject Matter Expert… more
- Merck (Albany, NY)
- …Trial Planning, Communication, Decision Making, Empathy, Market Access, Medical Affairs, Medical Research, Medical Review , Medical Writing, Patient ... **Job Description** **Role Summary:** The Sr. Global Director Medical Affairs (GDMA) is responsible for supporting the execution of scientific & medical affairs… more
- Cognizant (Albany, NY)
- …+ Experience in the analysis and processing of claims for payments, utilization review /quality assurance procedures. + Excellent problem-solving skill in ... with stakeholders and other teams. **Primary Responsibilities** : + Review claim system data and verify against UB or...UB or HCFA paper or EDI information. + Evaluate medical records to determine if the service rendered was… more
- Humana (Albany, NY)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with health ... part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims. The Corporate… more