- Molina Healthcare (Buffalo, NY)
- …and/or pharmacy internal monitors who support processes involved with the review of non-formulary drugs or other drugs requiring prior authorization. + ... speed to answer, and average hold time are compliant with Centers for Medicare and Medicaid Services (CMS) regulations. + Ensures that adequate staffing coverage is… more
- 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
- 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
- Evolent (Albany, NY)
- …for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a meaningful impact ... reviews for cardiovascular cases, serving as a specialty-matched expert reviewer for invasive/interventional cardiology cases (eg, cardiac catheterizations, coronary… more
- Evolent (Albany, NY)
- …Reviewers. **What You Will Be Doing:** + Serve as the specialty match reviewer in Cardiology cases, that do not initially meet the applicable medical necessity ... the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Albany, NY)
- …or required. **What You Will Be Doing:** + Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity ... rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… 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
- Molina Healthcare (Buffalo, NY)
- …Company's assigned contact to log tickets for premium restoration such as Medicare Secondary Payer and ESRD. **JOB QUALIFICATIONS** **Required Education** HS Diploma ... or GED **Required Experience** 1-3 years' experience in an administrative support. **Preferred Education** Associate degree **Preferred Experience** 3+ years' experience in an administrative support role. To all current Molina employees: If you are interested… more