- Evolent (Albany, NY)
- …compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation ... under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person"… more
- New York State Civil Service (Bronx, NY)
- …a human services field and 3 years of utilization review experience in a health care facility regulated by Centers for Medicare and Medicaid Services Utilization ... NY HELP Yes Agency Mental Health , Office of Title Utilization Review Coordinator, (NY...generous benefits package including:* NYS medical, dental, & vision insurance * Access to tuition assistance programs* Excellent opportunities for… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Associate Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and ... to an organization focused on continuously improving consumer experiences + 3+ years health industry experience with ASA, or 1+ years health industry experience… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Senior RX Clinical Programs Pharmacist integrates programs developed to improve overall ... health outcomes with a focus on prescription drugs. The...Previous experience with pharmacy benefits management + Previous Commercial, Medicare and/or Medicaid experience + 3 or more years… more
- CenterWell (Albany, NY)
- **Become a part of our caring community and help us put health first** The Care Delivery Call Quality Professional works within the PCO Growth and Retention group. ... and monitoring the Tele Sales Agents who are responsible for converting Medicare eligible callers to patients. The Care Delivery Call Quality Professional is… more
- Cognizant (Albany, NY)
- …Necessity Reviews can be based on InterQual, Milliman Clinical Guidelines (MCG), Medicare guidelines, and health insurer specific guidelines. . Review ... denial management and managing clinical denials from Providers to the Health Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing… more
- Stony Brook University (East Setauket, NY)
- …with Cerner Invision and/or Cerner Millennium Patient Accounting. + Experience in Insurance Verification. + Experience working in Medicare FSS DDE system. ... party billing and collection agencies. + Identify issues and patterns with claims/ insurance companies and review to increase revenue and prevent unnecessary denials.… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... BSN or Bachelor's degree in a related field + Health Plan experience + Experience in utilization management or...criteria to ensure appropriateness of care preferred + Previous Medicare experience a plus + Milliman MCG experience preferred… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Technology Solution Implementation Professional delivers new technological solutions to ... Operations in electronic transmissions set-up for state regulatory partners, health information exchanges, and vendor partners. **Responsibilities:** Works with ETL… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Associate Director, HEDIS Operations of Non-Standard Supplemental for business operations ... of, numerous strategies required to ensure success for our Medicare Stars and Medicaid LOBs. The ideal candidate for...data to identify trends and opportunities for improved member health and measure compliance + Internal and external partnerships… more