- Humana (Albany, NY)
- …or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides medical ... caring community and help us put health first** The Medical Director relies on medical ...or Surgery specialties + Utilization management experience in a medical management review organization, such as Medicare … more
- Elevance Health (Latham, NY)
- ** Medicare Medical Director ** Location: This position will work a hybrid model (remote and office). The ideal candidate will must live within 50 miles of one ... be able to work Eastern Time Zone hours. The ** Medicare Medical Director ** is responsible...gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status… 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...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Possess analysis… 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 ... 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 (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 (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
- Evolent (Albany, NY)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Albany, NY)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director you will be a key member of the utilization management team. ... recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- 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 ... Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity...and consistent responses to members and providers. As a Medical Director you will focus primarily on… more
- Humana (Albany, NY)
- …of our caring community and help us put health first** The Associate Director , Actuarial provides actuarial support across a broad range of actuarial and business ... needs for specific product lines. The Associate Director , Actuarial requires a solid understanding of how organization capabilities interrelate across department(s).… more
- Humana (Albany, NY)
- …our caring community and help us put health first** The Associate Director , Cloud Architecture designs, builds, and maintains data processing architectures and ... and unstructured data to insights at enterprise scale. The Associate Director , Cloud Architecture requires an in-depth understanding of how organization capabilities… more
- Baylor Scott & White Health (Albany, NY)
- …adjudicated claims data to uncover trends and assist in managing and understanding incurred medical and pharmacy cost. - The Director will design, develop, and ... Overview:** Reporting to the VP, Value-based Care Analytics, the Director of Healthcare Economics and Trend Analytics will support...Baylor Scott & White Quality Alliance Commercial, DTE, and Medicare (MSSP ACO, Medicare Advantage) lines of… more
- Organon & Co. (Albany, NY)
- …needs while generating potential solutions that enhance partnership. Collaborating with the National Account Director , the RPAD participates in the development ... **Job Description** **The Position** The Regional Payer Account Director (RPAD) reports directly to the Executive Director , Regional Payer Accounts. The RPAD… more
- Humana (Albany, NY)
- …part of our caring community and help us put health first** The Director , Medicaid Trend Mitigation Strategy provides data-based strategic direction to identify and ... planning support for business segments or the company at large. The Director , Medicaid Trend Mitigation Strategy requires an in-depth understanding of how… more
- Humana (Albany, NY)
- …in the country. **Location:** remote The Insurance Strategy team supports Humana's Medicare and Medicaid lines of business. This business unit, Humana's largest, ... strategy for the business unit, evolving key dimensions of the Medicare Advantage growth strategy, developing a refreshed membership acquisition strategy, assessing… more
- Humana (Albany, NY)
- …part of our caring community and help us put health first** The Director , IT Portfolio Management for Enterprise Information Protection (EIP) develops and executes ... technology and innovation to improve and mature Humana's security posture. The Director develops and executes on programs defined to implement security controls,… more
- CVS Health (Albany, NY)
- …the vision, goals, and prioritization of clinical levers to enhance Medicare specialty drug benefits. Manage the product development lifecycle, including core ... **Required Qualifications** 10+ years demonstrated experience in Managed Care & Medicare business segment Adept at execution and delivery (planning, delivering, and… more
- Humana (Albany, NY)
- …organizations in the country. The Healthcare Strategy team supports Humana's Medicare and Medicaid business unit. This business unit, Humana's largest, comprises ... experience leveraging core consulting skills to support delivering some of Medicare and Medicaid's highest priority projects and initiatives, with an emphasis… more
- Whitney Young Health Center (Albany, NY)
- …other requirements; identifies performance issues and brings them to the attention of the Director of Revenue Cycle. + Evaluates medical record and coding to ... problem claims or insurance types as designated by the Director . Reviews payer coding policies and procedures to ensure...service provision, patient case management, follow-up, and billing; Local Medical Review Policies (LMRP) for Medicare and… more
- CenterWell (Clifton Park, NY)
- …audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers ... of care and outcome planning. + Works in conjunction with the Branch Director and Company Finance Department to establish location's revenue and budget goals. +… more