- Evolent (Albany, NY)
- …Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director . + Appropriately identifies potential ... write clearly. + Reviews adverse determinations against criteria and medical policies + Creates adverse determination notifications that meet...patient care + **Minimum one year of experience with Utilization Review ( UM ) in a managed care… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …Management/ Utilization Management (QM/ UM ) Plan, including having the BH Medical Director for Children's Services and participate on the BH committees ... of the Children's Behavioral Health (BH) Carve-In program. The Medical Director for BH Children's Services has...rounds. + Provision of clinical oversight and leadership to Utilization Management/Case Management ( UM /CM) staff working with… more
- 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 ... but not limited to, Medical and Pharmacy Utilization Management, quality management, member care management, and ...and medical criteria. + Assists with training medical director colleagues and nursing staff ,… more
- Molina Healthcare (New York, NY)
- **JOB DESCRIPTION** **Job Summary** The Medical Director for Specialty Medical Services & Market Performance will provide clinical expertise and support to ... at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under- utilization...activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. +… more
- Molina Healthcare (Syracuse, NY)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under- utilization...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Evolent (Albany, NY)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... developing cardiovascular programs that include improvements to clinical effectiveness of utilization management ( UM ) and risk-based models.** + Process… more
- Molina Healthcare (New York, NY)
- …Board Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease… more
- CVS Health (Albany, NY)
- …System eg, Clinical Practice and Health Care Industry. *Prior UM ( Utilization Management) experience *Active and current state medical license without ... have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical… more
- Catholic Health Services (Melville, NY)
- …Physician Advisors during the monthly Physician Advisor meeting. Attends hospital Utilization Management ( UM ) committees. Supervises the Facility Physician ... Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR), discharge planning (DP), LOC and clinical documentation.… more
- Independent Health (Buffalo, NY)
- … necessity decision; and preparing request for review by assigned medical director , as needed. + Perform utilization of behavioral health (BH) services for ... procedure, identify, and refer potential quality of care and utilization issues to Medical Director ....annual program evaluations and Work Plans for the BH UM and/or CM Programs. + Aid department efforts with… more