• Director Utilization Management

    Healthfirst (NY)
    …identify areas for improvement + Lead initiatives to improve efficiency, cost-effectiveness, and quality in the UM program , sometimes through the ... requirements + Deliver on Healthfirsts Mission by ensuring optimum quality of member care in a cost-effective manner +...subject matter expert on business development efforts related to UM programs , including the launch of new… more
    Healthfirst (12/04/25)
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  • Medical Director , Commercial Line…

    Excellus BlueCross BlueShield (Rochester, NY)
    …is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical Services area ... including, but not limited to, Medical and Pharmacy Utilization Management, quality management, member care management, and medical policy processes, and support for… more
    Excellus BlueCross BlueShield (12/29/25)
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  • Medical Director (Medicare)

    Molina Healthcare (Syracuse, NY)
    …ability to learn new programs . Preferred Qualifications * Experience with utilization/ quality program management. * Managed care experience. * Peer review ... the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Determines appropriateness… more
    Molina Healthcare (01/07/26)
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  • Appeals Manager

    BronxCare Health System (Bronx, NY)
    …activities and monitoring on a quarterly basis and reports findings/analysis to Director . - Conducts educational/feedback sessions with UM staff related to ... and readiness. Assist in the design and implementation of educational programs for Denial Prevention and Management. Responsibilities - Establish and maintain… more
    BronxCare Health System (12/18/25)
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  • Case Manager, RN (Multiple Openings!)

    Excellus BlueCross BlueShield (Rochester, NY)
    …of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation ... Job Description: Summary: Conducts case management program activities in accordance with departmental, corporate, NYS...work with internal and external stakeholders for value-based payment programs , such as accountable cost and quality … more
    Excellus BlueCross BlueShield (01/13/26)
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