• National Health Care Associates (Poughkeepsie, NY)
    …understanding of Electronic Medical Record (EMR), PDP, MDS 3.0, Medicaid and Medicare requirements + Interest in the nursing needs of the aged and the ... our team! **-** **What You'll Do:** As an MDS Director , you will manage the Minimum Data Set (MDS)...this exceptional opportunity. Join our team as an MDS Director in an organization where your expertise and dedication… more
    DirectEmployers Association (12/10/25)
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  • Medical Director ( Medicare )

    Molina Healthcare (Syracuse, NY)
    JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting ... and cost-effective member care. Essential Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports… more
    Molina Healthcare (01/07/26)
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  • OneHome - Medical Director - Part…

    Humana (Albany, NY)
    …of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... SNF, DME, dual Medicare /Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided… more
    Humana (11/27/25)
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  • Medicare Annual Wellness Visit Registered…

    SUNY Upstate Medical University (Syracuse, NY)
    …and Practice Operations and collaborate closely with Primary Care clinic Medical Directors and Nurse Leadership. Duties/Responsibilities: Identify Medicare ... Job Summary: Position Summary: Upstate University Medical Associates at Syracuse Inc. (UUMAS) is seeking...or Certified Nurse Specialist (CNS), to coordinate and conduct Medicare Annual Wellness Visits (AWVs) across seven Primary Care… more
    SUNY Upstate Medical University (11/26/25)
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  • Medical Director - Pharmacy Appeals

    Humana (Albany, NY)
    …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director will collaborate with clinicians and support staff… more
    Humana (12/03/25)
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  • Medical Director - Medicaid (remote)

    Humana (Albany, NY)
    **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
    Humana (01/01/26)
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  • Medical Director -Payment Integrity

    Humana (Albany, NY)
    **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
    Humana (12/11/25)
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  • Medical Director - IP Claims…

    Humana (Albany, NY)
    **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
    Humana (12/11/25)
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  • Medical Director - Nat'l IP UM Team

    Humana (Albany, NY)
    …Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and ...to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all… more
    Humana (11/15/25)
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  • Medical Director /Associate…

    SUNY Upstate Medical University (Syracuse, NY)
    Job Summary: Medical Director -Associate Professor/Professor in the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology. Clinical ... Responsibilities: Maintain an active clinical practice in Gynecologic Oncology including medical and surgical management and chemotherapy. Assume leadership role in… more
    SUNY Upstate Medical University (10/14/25)
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