• Corporate Medical Director…

    Humana (Albany, NY)
    …a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims ... and preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
    Humana (04/24/25)
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  • Medical Director - Medicare…

    Humana (Albany, NY)
    …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
    Humana (05/14/25)
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  • Director , Appeals & Grievances…

    Molina Healthcare (Yonkers, NY)
    …with the standards and requirements established by the Centers for Medicare and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the ... activities of the Appeals & Grievances unit that is responsible for reviewing and resolving member complaints and communicating resolution to members or authorized… more
    Molina Healthcare (05/16/25)
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  • Medical Director , Children's…

    Excellus BlueCross BlueShield (Buffalo, NY)
    …and implementation of the Children's Behavioral Health (BH) Carve-In program. The Medical Director for BH Children's Services has overall accountability for ... of the Quality Management/Utilization Management (QM/UM) Plan, including having the BH Medical Director for Children's Services and participate on the BH… more
    Excellus BlueCross BlueShield (05/10/25)
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  • Medical Director Specialty…

    Molina Healthcare (New York, NY)
    **JOB DESCRIPTION** **Job Summary** The Medical Director for Specialty Medical Services & Market Performance will provide clinical expertise and support to ... activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. +...Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care.… more
    Molina Healthcare (04/11/25)
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  • Social Services Director v

    Bassett Healthcare (Herkimer, NY)
    …the best quality of life possible. What you'll do The primary purpose of the Director of Social Services is to plan, organize, develop the Social Services Program in ... receive the highest degree of care while their social, medical and emotional needs and rights are met. The...to benefit from his/her stay with the facility. The Director of Social Services will be involved with the… more
    Bassett Healthcare (05/20/25)
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  • Director , Grievance and Appeals

    Humana (Albany, NY)
    …first** The Resolution team handles all complaints for Humana, including formal grievances , appeals, inquiries and disputes. Our mission is to resolve these ... associates, members and providers. As the Resolution Team Operations Director ( Director , Grievance and Appeals), you will...starting your FIRST day of employment. Benefits include: + Medical Benefits + Dental Benefits + Vision Benefits +… more
    Humana (05/30/25)
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