- Molina Healthcare (Rochester, NY)
- …+ Reviews medically appropriate clinical guidelines and other appropriate criteria with Chief Medical Officer on denial decisions. + Resolves escalated ... + Prepares and presents cases in conjunction with the Chief Medical Officer for Administrative Law Judge...experience (such as specialties in: surgical, Ob/Gyn, home health, pharmacy , etc.). + Experience demonstrating knowledge of ICD-9, CPT… more
- St. John Fisher College (Rochester, NY)
- …Senior Project Manager, Principal, Superintendent, Associate Provost, Senior Vice President, Chief Financial Officer , Executive Director, Chief Executive ... programs; and master's and doctoral programs in business, nursing, education, pharmacy , and public health. The University's residential campus boasts a robust… more
- Molina Healthcare (Rochester, NY)
- …committees as required such as Credentialing, P&T and others as directed by the Chief Medical Officer . + Evaluates authorization requests in timely support of ... providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. + Develops and implements… more