• Medical Director (NV)

    Molina Healthcare (Albany, NY)
    …reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * ... medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse… more
    Molina Healthcare (11/21/25)
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  • Director Utilization Management

    Healthfirst (NY)
    …but not limited to Care Management, Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to align utilization decisions** + **Partner ... **Work experience and deep familiarity of health plans such as Medicare, Medicaid and//or Managed Long-Term Care Plan (MLTCP).** + **Demonstrated understanding of UM… more
    Healthfirst (12/04/25)
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