- Excellus BlueCross BlueShield (Rochester, NY)
- …you see is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical ... reviews and may require peer-to-peer discussions with providers regarding UM case review determinations. + Provides clinical expertise on...and medical criteria. + Assists with training medical director colleagues and nursing staff ,… more
- Catholic Health Services (Melville, NY)
- …the monthly Physician Advisor meeting. Attends hospital Utilization Management ( UM ) committees. Supervises the Facility Physician Advisors. Observes Catholic Health ... Physician Advisor meeting. 3. Training and Education Responsible for hiring and managing Physician Advisors, along with developing and monitoring compliance with an… more
- Independent Health (Buffalo, NY)
- … medical necessity decision; and preparing request for review by assigned medical director , as needed. + Perform utilization of behavioral health (BH) ... standards set by regulatory and accreditation entities. + Refer appropriate cases to the Medical Director for review and work closely with Case Management to… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director , Pharmacist, Geriatrics, etc.) to ensure continuity ... policy and leadership, current NYS DOH, CMS regulations and standards if managing members of Medicare programs, and other regulatory requirements as applicable. +… more