Lead Medical Director Payment Integrity & Utilization
Clover Health
You're now leaving the Clover Health Website. The information you will be accessing is provided by another organization or vendor. If you do not intend to leave our site, please click Cancel. Clover provider services uses a third-party website. The form for submitting a provider service request is hosted on a non-Clover website. However, the requests are read and responded to by Clover. If you do not wish to submit a service request via a non-Clover website, please click Cancel. Traditional Medicare covers hospitals (Part A) and doctors (Part B), and you pay standard rates for services. You can go to any doctor, hospital or other provider that accepts Medicare patients anywhere in the country. You can add drug coverage (Part D) by enrolling in a private "stand-alone" drug plan for an additional premium. You can buy separate Medigap insurance to cover some or most of the out-of-pocket costs of hospitals (Part A) and doctors (Part B). We found multiple counties for your ZIP code. #J-18808-Ljbffr
Vacancy posted 3 days ago
Similar jobs that could be interesting for youBased on the Lead Medical Director Payment Integrity & Utilization in New York, NY vacancy
$211.55k - $317.33k
...A leading healthcare technology firm seeks a Senior Medical Director to provide strategic oversight for pre-payment edits and improve payment integrity. The role involves collaboration with executive leadership and various stakeholders, ensuring innovative healthcare solutions...SuggestedRemote workLyric
New York, NY3 days ago$211.55k - $317.33k
...A leading healthcare technology firm in the United States is seeking a Senior Medical Director. This pivotal role involves providing strategic oversight for... ...development and improvement of pre-payment edits to ensure robust payment integrity. Candidates must be board-...SuggestedLyric
New York, NY3 days ago$211.55k - $317.33k
...Color Employer, LLC is seeking a Senior Medical Director to provide clinical leadership and oversee the development of payment integrity strategies. This role involves collaborating with executive leadership, clinical teams, and external stakeholders, ensuring that Lyric...SuggestedFull timeColor Employer, LLC
New York, NY5 days ago- ...Valenz is hiring a Sr. Compliance Specialist – Payment Integrity to provide compliance oversight for regulatory requirements impacting claims, billing, reimbursement, and payment activities. The role involves strategic guidance, operational compliance, and risk management...SuggestedRemote work
Valenz
New York, NY22 hours ago $83.25k - $155.51k
Molina Healthcare is seeking a Lead Analyst for health plan payment integrity in Kentucky. This role involves driving financial performance, managing operational projects, and analyzing data to ensure compliance with regulations. Ideal candidates will have extensive experience...SuggestedRemote job$70 - $74 per hour
...A leading staffing firm is looking for a WACS Functional Lead in Folsom, NJ. You will lead integration workstreams utilizing Oracle Integration Cloud for transformation projects in Oracle Utilities applications. The ideal candidate will have at least 6 years of hands-...Contract workManpowerGroup Global, Inc.
New York, NY4 days ago$92.7k - $139.1k
...you’re at in the organization, you’re an integral part of our team and your input,... ...Conduct complex, in‑depth analysis of claim payments and its methodology, identifying trends... ...(s) and providers as applicable. Ensure medical claims, records, and other documentation...Contract workWork at officeRemote workWork from homeFlexible hoursShift work2 days per week1 day per week- ...Team8 Inc. is seeking a Payment Accuracy and Concept Lead to develop audit concepts in healthcare using the Bluespine platform. This role involves identifying medical billing errors and fraudulent claims while collaborating with Medical Coders and Data Sciences teams....Remote work
Team8
New York, NY3 days ago - ...Product Consultant for Utilization Management is a member... ...who will serve as an integral contributor in the delivery... ...Experience leading a Utilization Management... ...providers simplify healthcare payments and yield powerful... ...benefits package with three medical plans and a Health...Live outLocal areaRemote workFlexible hours
Waystar
New York, NY23 hours ago - ...Product Consultant for Utilization Management is a member... ...who will serve as an integral contributor in the delivery... ...meets. Experience leading a Utilization... ...providers simplify healthcare payments and yield powerful results... ...benefits package (3 medical plans with Health...Live outLocal areaRemote workFlexible hours
Waystar
New York, NY3 days ago - ...Now Hiring: Medical Director – Utilization Management 100% Remote | Must work PST hours Medicare Advantage | Inpatient & Post-Acute Focus... ...experienced Medical Director (Utilization Management) to help lead clinical integrity and medical necessity decision‑making across...Immediate startRemote work
Appworkshub
New York, NY3 days ago $120 per hour
...the job poster from The Judge Group Medical Director – National Utilization Management Team (One Weekend per... ...perm based on performance Reports To: Lead Medical Director Summary: In this... ...decisions. This position requires strong integrity, professionalism, and the ability...Ongoing contractPermanent employmentFull timeContract workImmediate startRemote workThe Judge Group, LLC
New York, NY3 days ago$130 - $140 per hour
...Remote Medical Director - Utilization Management (6-12 month contract, potential for long-term hire!) Job Summary Medix is partnering with a premier... ...in payer-side medical management who can seamlessly integrate into a high-impact clinical review team. You will support...Hourly payContract workRemote workFlexible hoursMedix
New York, NY2 days ago- ...A leading healthcare organization is looking for a Cardiology Field Medical Director. In this role, you will be pivotal in utilization management, conducting specialty reviews and providing clinical rationale for appeals. Required qualifications include an MD/DO degree...
Evolent
New York, NY3 days ago - Cotiviti is seeking a Senior Payment Accuracy Specialist in Idaho to innovate and enhance audit processes. The successful candidate will have a degree, SQL proficiency, and at least three years of relevant experience. This key role includes developing new audit concepts...
- ...MetroPlus in New York seeks a Medical Director focused on health care utilization management. The position involves overseeing medical necessity reviews, conducting... ...license and demonstrate strong competencies in integrity, communication, and customer focus. #J-18808-Ljbffr...Remote work
MetroPlus
New York, NY22 hours ago - ...Essen Medical Associates in New York is seeking a Behavioral Health Associate Medical Director to lead the development and clinical oversight of behavioral health services. This... ...while demonstrating a strong interest in integrated care models. A competitive salary and...
Essen Medical Associates
New York, NY5 days ago - ...Bluespine-Payment Accuracy and Concept Lead (AI-Driven) Location: Remote, US Remote Description Bluespine... ...developing an engine that detects errors in medical billing, which causes billions of... ...claims for commercial payers. Utilized Bluespine platform to develop and enhance...Contract workRemote work
Team8
New York, NY3 days ago $128.09k - $192.14k
...Solutions, LLC is seeking a Workday Integration Student Senior Principal... .... In this role, you will lead implementation projects and coordinate... ...confirm requirements. You'll utilize your technical expertise to... ...alongside benefits including medical, paid time off, and a 401(k)...Collaborative Solutions
New York, NY2 days ago$146k - $190k
## Veterinary Integration Lead – Therapeutic DiagnosticsApplylocations: Parsippanytime type: Full... ...– Therapeutic Diagnostics serves as a medical lead within Global Diagnostics Medical... ...development initiatives that unlock clinical utility, streamline adoption, and connect...Full timeTemporary workWork at officeRemote workZoetis Spain SL
New York, NY4 days ago- Essen Medical Associates is seeking a Behavioral Health Associate Medical Director to lead the development and oversight of our behavioral health services. This role involves... ...position offers an opportunity to create integrated care models and improve systems of care for...
$256k
...Broadway as Associate Medical Director. Our dedicated... ...-centered, fully integrated, and innovative ambulatory... ...Details: ~ Leads and implements the clinical... ...Gap and Value-based payment (VBP) metrics and works... ..., and consistently utilizes and facilitates strategies...Immediate startFlexible hoursWeekend workAfternoon shiftPhysician Affiliate Group of New York, P.C.(PAGNY)
New York, NY21 days ago$89k - $148k
...delivering meaningful results, leading teams, and managing complex... ...this role, you’ll lead revenue integrity consulting projects, guide... ...state charge capture operations, utilize data to uncover patterns and... ...workplace.Benefits include:* Medical, Rx, Dental & Vision...Temporary workRemote workFlexible hoursDovel Technologies
New York, NY3 days ago- ...Utility Lead At Villa Restaurant Group, our mission is to deliver an exceptional guest... ...Restaurant Group? Competitive Pay Medical, Dental & Vision Benefits Paid Time... ...Villa Restaurant Group, we believe in Integrity, Family Hospitality, Passion, Innovation...Flexible hoursShift workDay shiftAfternoon shift
- About Fin Fin is a next-generation payments platform built for high-value, global, and instant... ...’re looking for a Business Development Lead whose primary goal is to get... ...and engineering to define straightforward integration paths and keep partnerships moving from...Worldwide
- WHO WE ARE Zinnia is the leading technology platform for accelerating life and annuities... ...comes to checks, wires, ACH, and complex payment workflows. You are highly analytical,... ...passionate about enforcing quality in both data integrity and system behavior. With a solid...
- ...Workday Integration Practice Manager – Student & Platform page is loaded## Workday Integration... ...Platform integrations. This role leads a high-performing team of Integrations and... ...offshore resources.* Own delivery quality, utilization, capacity planning, and continuous improvement...Local areaRemote work
Alchemy
New York, NY3 days ago $129k - $171.1k
...FanDuel is hiring a Lead Product Manager to drive... ...strategy and execution of Payments across our portfolio... ...: Partner with the Director of Payments Product, define... ...performance and integration issues, evaluate new capabilities... ...following benefits: medical, vision, and dental...Temporary workLocal areaWorldwideShift workFanDuel
New York, NY5 days ago$175k - $225k
...Lead Product Manager - Payments New York City Are you passionate about solving complex challenges... ...with speed and rigor. Own partner-integrated consumer flows, working directly with... ...PTO ~ Flexible benefits: annual medical allowance, productivity allowance, gym...Flexible hoursBreeze
New York, NY1 day ago- ...Experience in retail/e-commerce/OMS integration, including orders, inventory, shipping, returns, and payments. In-depth understanding... ...Roles & Responsibilities Lead integration and data projects... ...Incentive. Comprehensive Medical Coverage: Medical & Health,...
Tata Consultancy Services
New York, NY4 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Lead Medical Director Payment Integrity & Utilization. Be the first to apply!
Related searches
- medical affairs manager New York, NY
- clinical operations supervisor New York, NY
- director sr. director clinical operations New York, NY
- healthcare program manager New York, NY
- medical sales manager New York, NY
- medical marketing manager New York, NY
- medical product manager New York, NY
- clinical engineering manager New York, NY
- medical assistant supervisor New York, NY
- medical assistant manager New York, NY