- Humana (Albany, NY)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, DME, skilled nursing facility and… 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
- CenterLight Health System (NY)
- …areas for Center Light Healthcare System. + Works with Site Medical Director/Attending Physician and Nursing in QA review of their respective disciplines as ... appropriate. + Review and analyze monthly financial reports submitted by Medicare related to diagnostic data. + Present HCC/RAF performance results and findings… more
- New York State Civil Service (Middletown, NY)
- …a higher-level Psychiatrist or Physician . http://www.linkedin.com/company/nys-office-for-people-with-developmental-disabilities/posts/?feedView=all #LI-JL2 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 (Thiells, 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
- 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 ... location. 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
- Molina Healthcare (New York, NY)
- …appeals and supporting market performance. Performance activities include physician auditing, training, and performance improvement activities. Additionally, they ... medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred… more
- Stony Brook University (Stony Brook, NY)
- …may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR from the ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...Documents over utilization of resources and services. + All Medicare cases are reviewed for level of care on… more
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