- Humana (Albany, NY)
- …group practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid + ... other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will understand how… more
- Molina Healthcare (Rochester, NY)
- …Summary** Responsible for leading, organizing and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance with ... the standards and requirements established by the Centers for Medicare and Medicaid. **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of… more
- CVS Health (New York, NY)
- …all with heart, each and every day. **Position Summary** Within CVS Health, Aetna Medicare brings essential care to the nation's seniors and is a critical growth ... creativity and strategic thinking to our work. The Sr. Marketing Manager, Medicare Acquisition Marketing will support the development and execution of cross-channel… more
- Healthfirst (NY)
- …of material reviews in HPMS. + Actively participates in the annual Medicare Go to Market process, including working with internal stakeholders on developing ... regulatory agencies for status including approvals/denials. + Coordinates a review of the website with business owners and ensures...deliverables as needed. + Assists in the preparation of Medicare Part C and D reporting via HPMS, including… more
- Molina Healthcare (Yonkers, NY)
- …PST hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** **Job Summary** Responsible for reviewing and resolving ... with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research… more
- Staffing Solutions Organization (Albany, NY)
- …& Marketplace Integration (DEMI)** **Bureau of Third-Party Health Insurance, Medicare Savings Program and Recoveries** **Telecommuting Option:** This position is ... be successful in the position: + Work independently to review information submitted relative to Third Party Health Insurance...from a variety of sources such as Centers for Medicare and Medicaid Services (CMS), Insurance Carriers, and others.… more
- 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 (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
- Molina Healthcare (Yonkers, NY)
- …Enrollment activities (along with other Core Ops areas of responsibilities) within Medicare and Medicaid. Role is predicated on building relationships with vendors, ... Level Agreements between the parties. **Job Duties** + Develops Medicare and Medicaid vendor strategies aligned with CMS and...for additional vendor funding as required. + Oversee the review , reconciliation, and approval of invoices for payment of… more
- Molina Healthcare (Yonkers, NY)
- …and expertise in the performance of prior authorization, inpatient concurrent review , discharge planning, case management and interdisciplinary care team activities. ... Medical Directors + Develops medical policies and procedures + Conducts peer review **JOB QUALIFICATIONS** **REQUIRED EDUCATION:** * Doctorate Degree in Medicine *… more