- Staffing Solutions Organization (Albany, NY)
- …is in the Medical Evidence Gathering Group (MEGG) of the State Disability Review Unit. The incumbents will be responsible for gathering medical evidence for Medicaid ... experience in public health insurance programs, including New York's Medicaid, Medicare and/or Child Health Plus. Preferred candidates will also have excellent… more
- Catholic Health Services (West Islip, NY)
- …Conditions of Participation. Implements care management programs, including utilization review , intake and discharge planning. Evaluates patient care data to ... is required. Current knowledge of NY Department of Health and Centers of Medicare and Medicaid regulations is required. Knowledge of Joint Commission Standards, and… more
- Evolent (Albany, NY)
- …from authoritative sources, including the American Medical Association (AMA), Centers for Medicare & Medicaid Services (CMS), Food and Drug Administration (FDA), and ... prior authorization lists, facilitating timely decision-making for clinical and business review teams. + Demonstrate strong analytical abilities, with a proven track… more
- Saratoga Hospital (Saratoga Springs, NY)
- …referrers in accordance with departmental policies and procedures. + Perform thorough review of all incoming documents via mail, fax, email, etc. and redirect ... a basic understanding of Patient-Centered Medical Home (PCMH) and Centers for Medicare and Medicaid Services (CMS) quality measures is preferred. + Strong… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …status of the issue. + Adjust claim(s) as warranted based on discussion and review of the provider's issue. + Deliver all information and questions in a positive, ... Plan for Healthy Living (CPHL), is a Managed Care Organization servicing members with Medicare and/or Medicaid. Our goal is to provide members and all those involved… more
- Humana (Albany, NY)
- …Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide their social security number, if it is ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- New York State Civil Service (NY)
- …* Training. * Peer review . LinkedIn: https://www.linkedin.com/company/nys-office-for-people-with-developmental-disabilities/posts/?feedView=all #LI-DA1 Minimum ... and maintain eligibility for full and unconditional participation in the Medicare and Medicaid programs. Continued employment will depend on maintaining eligibility.… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …and identifying any deficiencies. + Prepare summaries for management of quality review results, including basic analysis of identified trends. + Analyzes audit ... Experience Required: 2+ years of claim processing experience with a Medicaid/ Medicare Health Plan. Preferred: Experience in health insurance product environment.… more
- New York State Civil Service (NY)
- …of plan of care.* Participate in psychiatric peer review meetings as well as specialized team meetings.LinkedIn: ... and maintain eligibility for full and unconditional participation in the Medicare and Medicaid programs. Continued employment will depend on maintaining… more
- Mohawk Valley Health System (Utica, NY)
- …Protection Agency (EPA), National Fire Protection Association (NFPA), Centers for Medicare & Medicaid Services (CMS), and Department of Homeland Security (DHS) ... the hospital accreditation body (eg, DOH, DNV-GL). + Establish mechanisms to collect, review , and track data required by local, state, and federal entities. +… more