- CVS Health (Albany, NY)
- …have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical ... and consistent responses to members and providers. As a Medical Director you will focus primarily on...will focus primarily on review appeal cases for denied medical services. This includes First Level Appeals … more
- 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. The ... Corporate Medical Director works on problems of diverse scope and complexity...the managed care industry including Medicare, Medicaid and or Commercial products + Possess analysis and interpretation skills with… more
- 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...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… more
- 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 (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 ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … more
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- About The Role The Medical Director will be responsible in providing support to our commercial and worker's compensation self-funded clients seeking cost ... medical care. + Reviews and resolves retro reviews, appeals and grievances related to medical quality of care and actively participates in the functioning of… more
- Buffalo Hearing & Speech Center (Buffalo, NY)
- …by the accounts receivable manager. Experience in Medicare and Medicaid HMO's, Commercial payers such as ChampVA, Tricare, UHC, Aetna, Cigna, NYS Medicaid and ... up is to be done bi-monthly on assigned controls to include corrected claims, appeals , phone calls, or provider rep assistance to assure any missing or incorrect… more