- Humana (Albany, NY)
- …issues. manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, appeal or ... further request is warranted. The Grievances & Appeals Representative 4 + Review documents + Building cases + Inventory Management + Data Entry **Use your skills to… more
- Robert Half Finance & Accounting (Syracuse, NY)
- …to ensure accurate and timely reporting. Responsibilities: * Prepare and review monthly, quarterly, and annual financial statements to ensure accuracy and ... provide insights to department leaders. * Manage regulatory filings, including Medicare cost reports and state-specific financial disclosures, with precision. *… more
- Molina Healthcare (Syracuse, NY)
- …HCS Department staff workload for adherence to the Policies, Procedures, Guidelines, Medicare Model of Care, and deadlines. Assures oversight and direction of ... timely completion. + Actively participates in the Department auditing program to review and communicate findings with staff and identify opportunities for improved… more
- Molina Healthcare (Albany, NY)
- …Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, or other ... MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including the… more
- Humana (Albany, NY)
- …security architecture standards, and guiding engineering teams through the Technology Review Board and Architecture Review Board processes and participating ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Northern Rivers Family Services (Troy, NY)
- …and informal training and education to staff + Prescribe medications, monitor, and review of drug regimen for enrolled individuals + Participate in quality assurance ... community partners, and participate in any quality audit and utilization review + Provide on-site/community based/home visits, medication evaluations, and reviews… more
- Mount Sinai Health System (New York, NY)
- …outcomes. Utilizes internal and community resources, electronic medical record and Centers for Medicare and Medicaid data to educate patients and form a care plan ... timely fashion. 6. May supervise a team of Patient Navigators via chart review , face-to-face case discussions and performance reviews. 7. May work closely with MSH… more
- City of New York (New York, NY)
- …spending. This work includes identifying Medicaid clients who should apply for Medicare , identifying Medicaid clients who should be part of buy-in program, and ... DSS-AO executive office, and comply with external reporting mandates. Review and recommend the use of database queries and...and meet with program executives, or their designees, to review and analyze their requirements, to prioritize the tasks… more
- Staffing Solutions Organization (Albany, NY)
- …unit staff. The role includes general program administration responsibilities such as review of policy rules, data entry, document review and management, ... experience; professional experience in public health insurance programs, including Medicaid, Medicare and/or Child Health Plus. Preferred candidates will also have… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …and PH care across the UM/ CM staff. + Participates in clinical peer review recruitment and supervision. + Collaborates with Provider Relations staff to ensure an ... that other Behavioral Health medical directors reviewing pediatric cases review those cases in accordance with Company policies. +...without restrictions and free of sanctions from Medicaid or Medicare required. + Minimum of five (5) years of… more