• COB Coordinator

    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 business. ... managers, attorneys, other insurance companies, regulatory agencies (ie Centers of Medicare and Medicaid) and internal departments effectively. + Identify and… more
    Independent Health (05/20/25)
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  • Broker Channel Mgr-Columbus, OH

    Molina Healthcare (NY)
    …or relationship ended * Work as liaison between Molina and/or National Medicare Broker/FMO, Exchange GA, sales agents and other departments (ie Membership ... with projects: o Competitive benefit comparison o Monthly activity submission review o Assist with provider presentations * Collaborate effectively with Community… more
    Molina Healthcare (05/02/25)
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  • Medical Director, MSK Surgery

    Evolent (Albany, NY)
    …is a key member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical Directors and interacts with ... Manager. + Provides medical direction to the support services review process. Responsible for the quality of utilization ...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
    Evolent (05/20/25)
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  • Clinical Pharmacist - Coverage…

    CVS Health (Albany, NY)
    …an Oncology RPh Advisor in Government Services you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy ... responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for… more
    CVS Health (05/16/25)
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  • Risk Adjustment Trainer

    Datavant (Albany, NY)
    …the application of learning to the work environment through various methods + Review client level audits and advise training content to re-educate team on coding ... and understanding of HCC mapping and models + Experience with coding Medicare , Commercial and Medicaid risk adjustment charts + Understanding of Medicare… more
    Datavant (05/07/25)
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  • Field Medical Director, Oncology

    Evolent (Albany, NY)
    …provides clinical rationale for standard and expedited appeals. . Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD ... review process to reflect appropriate utilization and compliance with...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
    Evolent (05/20/25)
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  • Field Medical Director, Cardiology

    Evolent (Albany, NY)
    …available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance… more
    Evolent (05/16/25)
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  • Field Medical Director , Radiology (Urology)

    Evolent (Albany, NY)
    …provides clinical rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD ... review process to reflect appropriate utilization and compliance with...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
    Evolent (05/03/25)
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  • Field Medical Director, Interventional Cardiology…

    Evolent (Albany, NY)
    …available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance… more
    Evolent (04/30/25)
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  • Claim Appeals And Audit Specialist

    CenterLight Health System (NY)
    …applicable State, CMS, and contractual guidelines. This position emphasizes the appeals review and auditing of claims to drive process improvements and achieve ... measurable outcomes. JOB RESPONSIBILITIES: + Perform end to end claims appeals review process. Track appeals and process the appeals into timely and accurate… more
    CenterLight Health System (04/26/25)
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