- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- Molina Healthcare (Albany, NY)
- …capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk adjustment, disease ... and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure… more
- Centene Corporation (Queens, NY)
- …a fresh perspective on workplace flexibility. **Position Purpose:** The Senior Director , Healthcare Analytics leads analytic service delivery by aligning ... of tools and capabilities and appropriate deployment of supporting analytic teams. The director serves in a leadership function spanning the needs of multiple health… more
- Molina Healthcare (Yonkers, NY)
- …experience as a Molina Medical Director + Demonstrated experience in Utilization /Quality Program management + Previous leadership experience + Peer review, ... of prior authorization, inpatient concurrent review, discharge planning, case management and interdisciplinary care team activities. + Ensures that authorization… more
- Kyndryl (Albany, NY)
- …ultimately supporting execution. Partners will be focused on financial impact, utilization and contribution, client impact and leadership. **Contribute to Profitable ... as a strategic partner. + Bring consulting experience-preferably in the Healthcare space-to tailor engagements that resonate with industry-specific needs and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …of the Medical Services area including, but not limited to, Medical and Pharmacy Utilization Management , quality management , member care management , and ... State and Federal Mandates and maintains current and working knowledge of Utilization Management Standards. + Clinical skills are excellent and evidence-based… more
- Kyndryl (New York, NY)
- …ultimately supporting execution. Partners will be focused on financial impact, utilization and contribution, client impact and leadership. **Contribute to Profitable ... development; Secure client references **Operational Excellence:** + Achieve individual and team utilization targets + Lead the design of complex engagements and take… more
- Kyndryl (Albany, NY)
- …in contact center environments. + Excellent communication, presentation, and stakeholder management skills with C-Level. + Healthcare industry experience is ... leading healthcare -focused journey redesign from eligibility verification to care management . + Align contact center transformation with healthcare business… more
- Centene Corporation (New York, NY)
- …New York + Board certified in Internal Medicine or Family Medicine + Utilization Management experience and knowledge of quality accreditation standards. + ... functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. +… more
- Humana (Albany, NY)
- …Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in… more