- Molina Healthcare (Albany, NY)
- …national, state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM reviews + MD licenses required for the ... NCQA and URAC certifications. Develops and provides leadership for NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical… more
- UHS (Johnson City, NY)
- …needs, patient acuity, and staff skill mix. + Functions as a clinical consultant for patients, families, department staff, physicians and other hospital departments. ... Troubleshoots clinical and operational matters collaboratively. + Participates in the...policies, regulatory requirements and professional standards. Participates in the review and revision of department policies and procedures. +… more
- New York State Civil Service (Schenectady, NY)
- …to the medical director/designee for review and approval. * Conduct clinical review of discipline-specific treatment plans received from service providers, ... which impact revenue generation and ensures there are no duplication of clinical services. PRIMARY DUTIES AND RESPONSIBILITIES:* Ensure clinic intake and admission… more
- Stony Brook University (Stony Brook, NY)
- …with patient account team. + Facilitate communication between administration, billing, clinical , and financial team members to capture billing and ensure correct ... cord blood, immune effector cells, and HLA typing. + Review charges with BMT Program Manager and manage care...Program Manager and manage care departments for hospital and physician charges accrued. + Report and track yearly budgets… more
- Elevance Health (New York, NY)
- ** Clinical Operations Associate Medical Director** **Carelon Medical Benefit Management** **Radiology Benefit Management** Surgery (Including: General, Dermatology, ... an accommodation is granted as required by law._ The ** Clinical Operations Associate Medical Director** is responsible for supporting...case reviews for their board certified specialty. + Makes physician to physician calls to gather medical… more
- UHS (Johnson City, NY)
- …the safe and accurate administration of medications by verifying the clinical appropriateness of prescribed treatments and overseeing proper delivery methods, ... - $81.25 per hour, depending on experience Job Responsibilities + Review medication orders for appropriateness (dose, route, frequency, indication, interactions,… more
- UHS (Binghamton, NY)
- …Technician to join our Managed Care Contracting team. In this role, you will review and improve hospital, homecare, and physician contract management within the ... $30.90 per hour, depending on experience Job Responsibilities: + Collaborate with clinical and business leaders to meet project deliverables related to contract… more
- Mount Sinai Health System (New York, NY)
- …ideal candidate will possess advanced knowledge of professional charging, billing, physician fee schedules, Epic workflows and quality reporting measures. This ... knowledge of code data sets, Epic edits, and reimbursement. + Capacity to review , analyze and interpret managed care contracts, billing guidelines, and state and… more
- UHS (Johnson City, NY)
- …patients according to physician orders and pharmacy regulations + Review prescriptions for clinical appropriateness, potential drug interactions, allergies, ... the safe and accurate administration of medications by verifying the clinical appropriateness of prescribed treatments and overseeing proper delivery methods,… more
- Guthrie (Binghamton, NY)
- …to interpret and process outpatient prescription and provide the required prospective drug review patient counseling. The pharmacist must be able to review and ... patients. Essential Functions: 1) Prepares and dispenses medication orders per physician request according to established policies, procedures, and protocols. a)… more