- Molina Healthcare (Yonkers, NY)
- …internal compliance program, including annual, periodic, focal, etc. audits. * Request, review and perform oversight of internal corrective action plans (CAPs) for ... it relates to the finding. * Performs support via review and approval for Corporate Operations policies, procedures, guidelines...years or more + 5 years of experience in Medicare , DSNP and CSNP population, Enrollment, A&G, Claims, Compliance,… more
- CVS Health (Albany, NY)
- …to members and providers. As a Medical Director you will focus primarily on review appeal cases for denied medical services. This includes First Level Appeals / ... Second Level Appeals / Expedited Appeals / Appeal Hearings / Special Projects and Committee participation when needed. The Medical Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. The… more
- Bassett Healthcare (Cooperstown, NY)
- …of care (LOC) and hospital protocols to make recommendations for unit placement Review traditional Medicare fee for service (FFS) using the two-midnight rule ... liaison between emergency services, surgical services, nursing, finance, physicians, utilization review and medical records to ensure appropriate bed is assigned,… more
- WMCHealth (Valhalla, 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
- Evolent (Albany, NY)
- …provider and vendor contracting, compliance, population health (including utilization management), Medicare , and Medicaid. + Draft, review and negotiate ... President, Deputy General Counsel, the Attorney will prepare and review a variety of complex contracts and provide legal...of legal terms to promote efficiency. + Draft and review significant correspondence and other documents on behalf of… more
- Humana (Albany, NY)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to… more
- New York State Civil Service (New York, NY)
- …1 Psychiatric (NY HELPS), New York State Psychiatric Institute, Utilization review , P26749 Occupational Category Health Care, Human/Social Services Salary Grade 18 ... 10032 Duties Description The selected candidate will provide Utilization Review services, including but not limited to conducting daily...on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal… more
- Humana (Albany, NY)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department's… more
- Centene Corporation (New York, NY)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers on utilization… more
- Intermountain Health (Albany, NY)
- …Billing, Follow-Up, Collections) required + Knowledge of Medicaid and Medicare billing regulations required **Physical Requirements** + Operate computers and ... other office equipment requiring the ability to move fingers and hands. + Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment. + May require lifting and transporting objects and office supplies,… more