• Case Manager, Outpatient Clinic

    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 (08/08/25)
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  • Case Manager

    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 (08/08/25)
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  • 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)
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  • 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)
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  • Medical Director , MSK Surgery

    Evolent (Albany, NY)
    …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical...needed for new hires to educate and train on Utilization management system and Field Medical Director more
    Evolent (05/20/25)
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  • 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 (07/03/25)
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  • 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)
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  • Director of Case Management

    Stony Brook University (Stony Brook, NY)
    …design, development, implementation, and monitoring of the organization's case management and utilization review functions. + Lead initiatives to improve patient ... Director of Case Management **Position Summary** We are...and collaboration with Social Work Services * Knowledge of Utilization Review and Denial/Appeals * Knowledge of… more
    Stony Brook University (08/08/25)
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  • Medical Director - Florida

    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 ... health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review more
    Humana (07/29/25)
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  • Field Medical Director -Vascular Surgery

    Evolent (Albany, NY)
    utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
    Evolent (08/03/25)
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