- Humana (Albany, NY)
- … management . + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences,… more
- Trinity Health (Albany, NY)
- …with litigated claims. Ensures that patient care-related incidents are reported to Trinity System Office, CMS , and/or the Department of Health as required by ... but not limited to: NYPORTS, NIMRS, Justice Center, STARS/ClearSight, Centers for Medicare and Medicaid Services ( CMS ) death reporting in restraints; ensuring… more
- ABBTECH Professional Resources, Inc. (Albany, NY)
- …impact as a Tableau/Data Visualization and Reports Analyst supporting the Centers for Medicare & Medicaid Services ( CMS ). It's your place to make meaningful** ... load with Apex Data Loader.** Healthcare Service Industry and/or Center for Medicare and Medicaid Services ( CMS ) experience.** Experience mentoring junior level… more
- CenterWell (Albany, NY)
- …DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare ... in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more
- CenterWell (Albany, NY)
- …procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare ... in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more
- Molina Healthcare (Rochester, NY)
- …to achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services ( CMS ) and State regulatory requirements are met ... **Job Qualifications** **REQUIRED QUALIFICATIONS:** + Experience demonstrating knowledge of CMS Guidelines, MCG, InterQual or other medically appropriate clinical… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …guidance and plans they need for healthy living. Outreach and Retention Associate (ORA)- Medicare Advantage CPHL is a Medicare Advantage Prescription Drug plan ... orient them on the CPHL benefits and health delivery system access. + Conduct daily surveys to members who...eligible for, + Answer inquiries related to all CPHL Medicare products *Licensed Agents Only. + Educate potential members… more
- Evolent (Albany, NY)
- …from authoritative sources, including the American Medical Association (AMA), Centers for Medicare & Medicaid Services ( CMS ), Food and Drug Administration (FDA), ... seek to connect the pieces of fragmented health care system and ensure people get the same level of...culture. **What You'll Be Doing:** **Senior Scope Analyst, Scope Management ** The Specialty Scope Management team is… more
- Molina Healthcare (Albany, NY)
- …to achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services ( CMS ) and State regulatory requirements are met ... including assisting and executing projects and tasks to ensure CMS and State regulatory requirements are met for pre-pay...At least 3 years of Experience with Medicaid and/or Medicare . + Proven experience owning operational projects from concept… more
- Independent Health (Buffalo, NY)
- …Independent Health policies, summary plan descriptions, member contracts, and Centers for Medicare and Medicaid Services ( CMS ) guidelines for all lines of ... acceptable level of production as outlined in the Claims/COB Performance Management Policy with minimal supervision and demonstrate basic problem-solving and… more