- MVP Health Care (Tarrytown, NY)
- …and continuous improvement. To achieve this, we're looking for a ** Medical Director , Post-Acute Care Utilization Management ** to join #TeamMVP. If you ... reviews, continued stay requests, and handling first-level appeals. + Collaborate with Utilization Management , Case Management , Quality Department and other… more
- Humana (Albany, NY)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Albany, NY)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Molina Healthcare (Yonkers, NY)
- …as a Molina Medical Director + Demonstrated experience in Utilization /Quality Program management + Previous leadership experience + Peer review, ... Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …departmental policy and procedure, identifies and refers potential quality of care and utilization issues to Medical Director . + Utilizes appropriate ... external standards set by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case… more
- Centene Corporation (New York, NY)
- …everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization ... of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them...criteria, referring those requests that fail review to the medical director for second level review and… more
- Evolent (Albany, NY)
- …for utilization management while working in conjunction with the Senior Medical Director . May assist the Senior Medical Director in ... , you will be a key member of the utilization management team. We can offer you...process. + On a requested basis, may function as Medical Director for selecting health plans or… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …of activities of the Medical Services area including, but not limited to, Medical and Pharmacy Utilization Management , quality management , member ... you, we encourage you to apply! Job Description: The Medical Director participates in the broad array...I Qualifications) + Minimum 2-3 years of experience in medical management , utilization review and… more
- Centene Corporation (New York, NY)
- …the Chief Medical Director to direct and coordinate the medical management , quality improvement and credentialing functions for the business unit. + ... Provides medical leadership of all for utilization management , cost containment, and medical...performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals… more
- Evolent (Albany, NY)
- …setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional cardiology ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management … more