- Humana (Albany, NY)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to… more
- Ellis Medicine (Schenectady, NY)
- …Level of Care and status on all patients through collaboration with Utilization Review RN + Contacts the attending physician for additional information if ... by the Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration with physicians and social workers for… more
- Intermountain Health (Albany, NY)
- …with Clinical Documentation Integrity (CDI) Registered Nurses (RN) and Intermountain Physician Advisors to review complex facility encounters and assign ... coding questions received by facility caregivers including CDI RNs, Quality and Physician Advisor Services MDs. This position supports higher level analytics for CDI… more
- Bassett Healthcare (Cooperstown, NY)
- … all admissions as soon as possible or within one hour of new admissions Review prior to admitting physician placing orders for admission Ensure on going ... Milliman Care Guidelines(R) (MCG) Collaborate with care team (ED physician , admitting physician , or other provider) on...and hospital protocols to make recommendations for unit placement Review traditional Medicare fee for service (FFS)… more
- New York State Civil Service (East Syracuse, NY)
- …a higher-level Psychiatrist or Physician . http://www.linkedin.com/company/nys-office-for-people-with-developmental-disabilities/posts/?feedView=all #LI-JB3 Minimum ... Credentials will be reviewed at the time of interview.Background Investigation/Justice Center Review : In some agencies, the names of all prospective employees will*… more
- New York State Civil Service (NY)
- …and procedures when needed to ensure the provision of quality care. * Review of lab work, specialty consults, hospital discharges, medical visit summaries and ... the group home, the hospital, the rehabilitation setting and/or community providers.* Review and approval of discharge summaries prior to accepting an individual… more
- Catholic Health Services (Roslyn, NY)
- …Training & Experience: Physician Assistant must be a graduate of a Physician Assistant program accredited by the Accreditation Review Commission on Education ... to receive a five-star rating from the Centers for Medicare & Medicaid Services for consistently high patient satisfaction...Physician Assistant must be a graduate of a Physician Assistant program accredited by the Accreditation Review… more
- New York State Civil Service (Schenectady, NY)
- …2 provides primary medical care, working in collaboration with other physician (s) and nurse practitioners or midlevel providers for adults with developmental ... Schuylerville. Duties would include but not be limited to review and establish medical histories, perform physical examinations, and...on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal… more
- Amgen (New York, NY)
- …HUB, providing live one-on-one coverage support + Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer ... prior authorization to appeals/denials requirements and forms + Review patient-specific information in cases where the site has...the products are covered under the benefit design (Commercial, Medicare , Medicaid) + Serve as a payer expert for… more
- 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 ... well as health plan members and staff whenever a physician `s input is needed or required. Responsible for clinical...Manager. + Provides medical direction to the support services review process. Responsible for the quality of utilization … more