• Case Manager l Supporting clients in-house &…

    Arms Acres (Bronx, NY)
    …life skills) as identified in patient treatment plans and requested by program director . Performs utilization review , provides progress reports and develop ... implementation of the multidisciplinary treatment plan; coordinates treatment plan review ; performs these activities within established time frames. Documents… more
    Arms Acres (08/15/25)
    - Related Jobs
  • Substance Abuse Counselor

    Arms Acres (Carmel, NY)
    …life skills) as identified in patient treatment plans and requested by program director . Performs utilization review , provides progress reports and develop ... implementation of the multidisciplinary treatment plan; coordinates treatment plan review ; performs these activities within established time frames. Documents… more
    Arms Acres (08/20/25)
    - Related Jobs
  • Utilization Review Nurse I

    Centene Corporation (New York, NY)
    …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review ... appropriateness and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review more
    Centene Corporation (08/02/25)
    - Related Jobs
  • Utilization Manager Reviewer, RN (Multiple…

    Excellus BlueCross BlueShield (Rochester, NY)
    …set by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management ... policy and procedure, identifies and refers potential quality of care and utilization issues to Medical Director . + Utilizes appropriate communication techniques… more
    Excellus BlueCross BlueShield (08/23/25)
    - Related Jobs
  • Integrity Review Director

    City of New York (New York, NY)
    …HPD's standards and maintain nondiscriminatory hiring and employment policies. As the Integrity Review Director , you would: - Oversee HPD's Integrity Review ... financial assistance from the Agency. Your Impact: As the Director of Integrity Review Unit, you will...- Make recommendations to executive management to optimize staff utilization and review throughput. - Analyze roadblocks… more
    City of New York (08/13/25)
    - Related Jobs
  • Medical Director , Commercial Line…

    Excellus BlueCross BlueShield (Rochester, NY)
    …recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range ... we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of...+ Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge… more
    Excellus BlueCross BlueShield (07/01/25)
    - Related Jobs
  • Remote Medical Director

    Centene Corporation (New York, NY)
    …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... of physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization more
    Centene Corporation (08/16/25)
    - Related Jobs
  • Field Medical Director , Interventional…

    Evolent (Albany, NY)
    utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
    Evolent (07/30/25)
    - Related Jobs
  • Medical Director - National Medicare

    Humana (Albany, NY)
    …understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to complex ... care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience in a medical management review...size of region or line of business. The Medical Director conducts Utilization Management of the care… more
    Humana (08/21/25)
    - Related Jobs
  • Director , Physician Leadership - Medical…

    Humana (Albany, NY)
    …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 ... The Director , Physician leadership will lead Medical Directors performing utilization management for inpatient authorizations training medical director team… more
    Humana (08/21/25)
    - Related Jobs