• Physician Advisor

    WMCHealth (Valhalla, NY)
    … of aggregate denials/ appeals with the Medical Director, peer, or the Clinical Review Supervisor. + Provides continuous education to physicians as needed on ... Physician Services PC City/State: Valhalla, NY Category: Physicians Department: Clinical Care Mgmt- WMC Health Union: No...Provides clinical rational for standard and expedited appeals . + Participate in peer-to-peer review with… more
    WMCHealth (05/22/25)
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  • RN Utilization Review - System Care

    Guthrie (Binghamton, NY)
    …Orthopedic Surgery Residency, as well as Cardiovascular, Gastroenterology and Pulmonary Critical Care Fellowship programs. Guthrie is also a clinical campus for ... Provides health care services regarding admissions, case management, discharge planning and utilization review . Responsibilites: Reviews admissions and service… more
    Guthrie (07/05/25)
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  • Medical Director, Clinical Services

    Highmark Health (Albany, NY)
    …to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. ... DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of...or Public Health **EXPERIENCE** **Required** + 5 years in Clinical , Direct Patient care (hospital, outpatient, or… more
    Highmark Health (07/29/25)
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  • Field Medical Director, Interventional Cardiology…

    Evolent (Albany, NY)
    …when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the ... you ready to make a meaningful impact on patient care in a non- clinical setting? Join our...to ensure the application of best practices. + Provides clinical rationale for standard and expedited appeals .… more
    Evolent (07/30/25)
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  • Nurse Practitioner/Physician Assistant,…

    Stony Brook University (Stony Brook, NY)
    …Medicine's **Advanced Practitioners** are valuable members of our team who provide clinical services to our patient population. We are seeking candidates to work ... East Setauket, Lake Grove and Commack offices to provide adult patient care under the supervision of the identified supervising physician. Qualified candidates will… more
    Stony Brook University (07/26/25)
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  • Field Medical Director, MSK (spine)

    Evolent (Albany, NY)
    …of the request. + Provides clinical rationale for standard and expedited appeals . + Utilizes medical/ clinical review guidelines and parameters to assure ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...Director, MSK Surgery you will be a specialty match reviewer for Spine Surgery cases. you will be a… more
    Evolent (08/19/25)
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  • Medical Director - Care Plus - Florida

    Humana (Albany, NY)
    …this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of ... work, communication of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise from inpatient… more
    Humana (06/28/25)
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  • Insurance Specialist-Mount Sinai West-Utilization…

    Mount Sinai Health System (New York, NY)
    …Utilization Management - WST, Mount Sinai West **Responsibilities** **A. Clinical /Technical/Service** + Demonstrates the ability to perform clinical ... + Requests or provides Medical Records as required for appeals , On / Off-site Insurance reviews + Implements...Insurance / State & Federal regulation. + Enters concurrent review information for Review Nurses in Allscripts… more
    Mount Sinai Health System (07/23/25)
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  • Physician Advisor

    Mohawk Valley Health System (Utica, NY)
    …managers and clinical documentation specialist regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, ... barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance...(RAC's). + Assist with mitigating barriers to discharge and care progression. + Perform concurrent review of… more
    Mohawk Valley Health System (07/09/25)
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  • Field Medical Director , Radiology (Urology)

    Evolent (Albany, NY)
    …of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical/ clinical review guidelines and parameters to assure ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...to make a difference in patients lives, in a non- clinical environment. You can enjoy better work- life balance… more
    Evolent (08/02/25)
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