• RN UM Clinical Appeals Nurse Remote

    Molina Healthcare (Buffalo, NY)
    …length of stay and level of care provided to members. Contributes to overarching strategy to provide quality and cost-effective member care. Candidates with UM ... Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ)… more
    Molina Healthcare (11/14/25)
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  • Healthcare Services Auditor (RN) (New York)

    Molina Healthcare (Bronx, NY)
    …ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job ... for Quality Assurance, Centers for Medicare and Medicaid Services ( CMS ), and state/federal guidelines and requirements. May also perform non-clinical system… more
    Molina Healthcare (11/09/25)
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  • Senior Project Manager, Claims Operations

    Molina Healthcare (Buffalo, NY)
    …system analysis and program staff. These positions' primary focus is project/ program management , rather than the application of expertise in a specialized ... (training, SOPs, job aids, communications). + Risk, Compliance & Quality : Ensure alignment to CMS , HIPAA, state...education and experience **Required Experience** + 5-7 years of project/ program management with direct impact on Claims… more
    Molina Healthcare (10/19/25)
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  • Director, Operational Excellence

    CenterWell (Albany, NY)
    …teams. ** Quality and Compliance:** + Oversee coding quality assurance programs to ensure accuracy and compliance with CMS , HHS, and other regulatory ... (5) years leadership experience overseeing multifaceted teams + Experience in program management and analytics **Preferred Certifications:** + Master's degree… more
    CenterWell (11/18/25)
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  • Business Systems Analyst 2 (Health) (NY Helps)

    New York State Civil Service (Albany, NY)
    …County Albany Street Address Office of Health Insurance Programs /Bureau of System Modernization/Portfolio Management Strategy and Operations Unit 11 ... System Modernization within the Office of Health Insurance Programs is seeking a qualified Business Systems Analyst 2...models, data flow diagrams, and similar documentation.* Familiarity with CMS programs , especially the AHEAD Model or… more
    New York State Civil Service (11/05/25)
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  • Compliance Manager - Credit Card Business…

    TD Bank (New York, NY)
    …responsible for: + Supporting the development, implementation, and maintenance of a compliance management system ( CMS ) program through compliance ... operations and in the design of a future-focused compliance program . This not just about implementing a new ...+ Guides partner through the development, implementation, oversight and management of effective Compliance Programs + Prepares… more
    TD Bank (10/30/25)
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  • Senior Compliance Business Oversight Analyst

    TD Bank (New York, NY)
    …testing, monitoring and assessing the adequacy of, adherence to and effectiveness of Compliance Management System ( CMS ) programs and controls in the ... operations and in the design of a future-focused compliance program . This not just about implementing a new ...and resource requirements; may lead end-to-end processes or functional programs + Contact for business management , external/internal… more
    TD Bank (11/13/25)
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  • Compliance Business Oversight Manager - Fiduciary…

    TD Bank (New York, NY)
    …testing, monitoring and assessing the adequacy of adherence to and effectiveness of Compliance Management System ( CMS ) programs and controls in the ... operations and in the design of a future-focused compliance program . This not just about implementing a new ...+ Guides partner through the development, implementation, oversight and management of effective Compliance Programs + Prepares… more
    TD Bank (11/19/25)
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  • PCO Medical Director - UM - Part Time (Hourly)

    CenterWell (Albany, NY)
    …with prior experienceparticipatingin teams focusing on transitions of care, quality management ,utilizationmanagement, case management , discharge planning ... to innovate. **Additional Information** Will report to the Director of Physician Strategy at Utilization Management . The Medical Director conducts Utilization… more
    CenterWell (11/06/25)
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  • Director Editorial Communications- PVH Corp.

    PVH Corp. (New York, NY)
    …**About the Role:** PVH is seeking a strategic and collaborative **Director of Editorial & Content ** to lead the content strategy and execution for our ... company's internal editorial platforms, and support the content strategy for PVH's external channels. Serving...drive aligned / 360 storytelling across platforms with consistency ** Content Management ** + Develop a quarterly editorial… more
    PVH Corp. (08/22/25)
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