• Sr Medicare Telesales Implementation Mgr…

    CVS Health (Albany, NY)
    …will play an instrumental role in helping to strengthen our Medicare Telesales organization. Our Implementation Manager will be responsible for coordinating ... further optimization, analyze progress of initiatives to implementation, coordinate routine review of business processes and suggest new strategizes based on risk… more
    CVS Health (05/22/25)
    - Related Jobs

  • Medical Director- Medicare (Part-time)

    Elevance Health (New Hyde Park, NY)
    **Medical Director- Medicare (Part-time)** Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... Candidates must be able to work Eastern Time Zone hours. The ** Medicare Medical Director** is responsible for the administration of physical and/or behavioral… more
    Elevance Health (05/17/25)
    - Related Jobs

  • Medical Director - Medicare Grievances…

    Humana (Albany, NY)
    …of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative ... established clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be passionate about… more
    Humana (05/14/25)
    - Related Jobs

  • Corporate Medical Director - Medicare…

    Humana (Albany, NY)
    …first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on ... clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate about contributing… more
    Humana (04/24/25)
    - Related Jobs

  • Customer Service Representative, Medicare…

    Molina Healthcare (Rochester, NY)
    …clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing ... and measuring performance metrics regarding patient outcomes, medications safety and medication use policies). **KNOWLEDGE/SKILLS/ABILITIES** + Handles and records inbound pharmacy calls from members, providers, and pharmacies to meet departmental, State… more
    Molina Healthcare (05/29/25)
    - Related Jobs

  • Medical Director, Behavioral Health

    Molina Healthcare (New York, NY)
    …unrestricted State Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review , medical policy/procedure development, ... quality and financial goals across all LOBs * Responds to BH-related RFP sections and review BH portions of state contracts * Assist the BH MD lead trainers in the… more
    Molina Healthcare (04/26/25)
    - Related Jobs

  • Manager Patient Accounts

    WMCHealth (Poughkeepsie, NY)
    …party billing companies, Medicare and Medicaid, as well as insurance denial review as appropriate. + Ability to multi-task in a fast and high pressure ... Facility Billing, Insurance Verifications, Third Party Insurance coverage, Medicaid and Medicare eligibility, Insurance denial review and overturn procedures. +… more
    WMCHealth (05/08/25)
    - Related Jobs

  • Medical Director - Care Plus - Florida

    Humana (Albany, NY)
    …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will...daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, … more
    Humana (04/24/25)
    - Related Jobs

  • Medical Director - OneHome

    Humana (Albany, NY)
    …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, DME, skilled nursing facility and… more
    Humana (05/31/25)
    - Related Jobs

  • Medical Director - Medicaid N. Central

    Humana (Albany, NY)
    …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
    Humana (05/14/25)
    - Related Jobs