- 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 ... diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the… more
- Healthfirst (NY)
- …+ Bachelors degree + Experience in clinical practice with experience in appeals & grievances , claims processing, utilization review or utilization ... (NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines + Ability to work independently...such as Microsoft Word and Excel, as well as corporate email and virtual filing system, (ie. Macess). Experience… more
- VNS Health (Manhattan, NY)
- …exciting opportunity to: * Lead with Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long Term Care (MLTC), ... high standards for operational and regulatory compliance in managing grievances and appeals on our behalf. *...Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), Part D, or Select Health to… more