- Healthfirst (NY)
- **Duties/Responsibilities:** + Lead, mentor, and support the HARP Care Management team, ensuring high clinical quality, member satisfaction, and employee ... managed care + Progressive leadership experience in medical and behavioral health care management including work experience in a senior management role… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Services area including, but not limited to, Medical and Pharmacy Utilization Management , quality management , member care management , and medical ... we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of... management , utilization review and case management . + Knowledge of managed care products… more
- Evolent (Albany, NY)
- …meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Molina Healthcare (Syracuse, NY)
- …adjustment, disease management , and evidence-based guidelines. + Experience in Utilization /Quality Program management + HMO/Managed care experience ... resource management . + Develops and implements a Utilization Management program and action plan, which...qualified medical personnel, not influenced by fiscal or administrative management considerations, and that the care provided… more
- Mount Sinai Health System (New York, NY)
- …exemplary professional practice Magnet standards. In collaboration with the Magnet Program Director ensures that the care delivery system is integrated within ... **Job Description** The Director of Nursing Professional Practice is a professional...Management Board process/practice improvement activities to facilitate the utilization of evidence and data related to Nurse Sensitive… more
- Northwell Health (Mount Kisco, NY)
- …patient care standards, policies and procedures to improve quality of patient care and plans utilization of staff resources and activities aimed at continued ... and evaluates all activities of the inpatient RN Case Management and Social Work Services team. Develops processes to...and Social Work Services team. Develops processes to monitor utilization review inclusive of length of stay (LOS) and… more
- Humana (Albany, NY)
- …Health Medical Director will attend and participate in meetings involving care management , provider relations, quality of care , audit, grievance ... metrics, population health, and disease or care management . The Behavioral Health Medical Director may...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Albany, NY)
- …The Director , Physician leadership will lead Medical Directors performing utilization management for inpatient authorizations training medical director ... role, you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus… more
- Mohawk Valley Health System (Utica, NY)
- …+ 8 years of clinical experience. Previous or current experience working in Quality Management / Utilization Management field. + 5 years of management ... Sr Director Quality Management & Regulatory Affairs...Determine opportunities to improve the value and equity of care and services to patients and families, working collaboratively… more
- Evolent (Albany, NY)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented... you will be a key member of the utilization management team. We can offer you… more