- Excellus BlueCross BlueShield (Buffalo, NY)
- …Develops and implements the BH sections of the Quality Management / Utilization Management (QM/UM) Plan, including having the BH Medical Director for ... 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… more
- Centene Corporation (New York, NY)
- … medical directors. Assume VPMA responsibility in absence of VPMA. + Provide medical leadership for all utilization management , pharmacy, case ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a...expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory,… more
- Mount Sinai Health System (Long Island City, NY)
- …data collection, data received from external agencies, Physician 9.Advisors and the Medical Director . 10.Ensures Discharge Appeals functions are carried out ... **Job Description** The Director will direct and manage departmental activities involved in utilization review, appeals management and discharge planning to… more
- STG International (Watertown, NY)
- STGi is currently seeking a Medical Director to provide services at our Community Based Outpatient Clinic. JOB SUMMARY: The general duty of the Medical ... conditions of the Veteran Affairs Primary Care Program. The Medical Director will also collaborate with the...safety. * Design and participate in quality improvement, care management , risk management , peer review, utilization… more
- STG International (Kingston, NY)
- THIS IS FOR A FUTURE OPENING STGi is currently seeking a Medical Director to provide services at our Community Based Outpatient Clinic. JOB SUMMARY: The general ... duty of the Medical Director is to provide oversight for...safety. + Design and participate in quality improvement, care management , risk management , peer review, utilization… more
- Mount Sinai Health System (New York, NY)
- …environments + Seek to improve the status quo **Role Summary:** MSHP seeks a Medical Director (MD), Physician Engagement and CDQI, who will (1) be responsible ... transition to a business model focused on population health management - our goal is to keep entire communities...to drive accurate risk adjustment throughout the system. This Medical Director must be effective at influencing… more
- Mount Sinai Health System (New York, NY)
- …Daily Management Board process/practice improvement activities to facilitate the utilization of evidence and data related to Nurse Sensitive Indicators and ... **Job Description** The Director of Nursing Professional Practice is a professional...to: Water Electricity Computer or IT services including Pyxis Medical gases Maintains all required Federal Emergency Management… more
- CVS Health (Albany, NY)
- …timely and consistent responses to members and providers. As a Medical Director you will focus primarily on overseeing utilization review / quality assurance ... the ability to obtain a NJ License. In the Medical Director role you will provide oversight...clinical / medical programs and expand Aetna's medical management programs to address member needs… more
- CVS Health (Albany, NY)
- … will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. The Medical Director will act as a ... eg, Clinical Practice and Health Care Industry. *Prior UM ( Utilization Management ) experience *Active and current state medical license without encumbrances… more
- Mohawk Valley Health System (Utica, NY)
- …+ 8 years of clinical experience. Previous or current experience working in Quality Management / Utilization Management field. + 5 years of management ... Sr Director Quality Management & Regulatory Affairs...regulatory information. + Ongoing relationships with DOH, DNV, Administration, Medical Staff, Nursing Staff, Program Directors and/or ancillary services… more