• Medical Director Physician…

    Mount Sinai Health System (New York, NY)
    **Job Description** **Mount Sinai Health System is seeking a Medical Director of Physician Engagement and CDQI!** **Background:** Mount Sinai is one of the ... improve the status quo **Role Summary:** MSHP seeks a Medical Director (MD), Physician Engagement...for driving key population health goals including access, quality, utilization and accurate risk adjustment with a group of… more
    Mount Sinai Health System (09/01/25)
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  • Director Physician Advisor

    Catholic Health Services (Melville, NY)
    …department, and presents to Physician Advisors during the monthly Physician Advisor meeting. Attends hospital Utilization Management (UM) committees. ... hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. At Catholic Health, our primary focus is the… more
    Catholic Health Services (06/27/25)
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  • Utilization Manager Reviewer, RN (Multiple…

    Excellus BlueCross BlueShield (Rochester, NY)
    …departmental policy and procedure, identifies and refers potential quality of care and utilization issues to Medical Director . + Utilizes appropriate ... position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and...regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and… more
    Excellus BlueCross BlueShield (08/23/25)
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  • Medical Director

    Centene Corporation (New York, NY)
    …state, corporate, and accreditation requirements. + Assists the Chief Medical Director in the functioning of the physician committees including committee ... + Actively practices medicine **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the...and credentialing functions for the business unit. + Provides medical leadership of all for utilization management,… more
    Centene Corporation (08/27/25)
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  • Medical Director , Commercial Line…

    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
    Excellus BlueCross BlueShield (07/01/25)
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  • Medical Director (Marketplace)

    Molina Healthcare (Albany, NY)
    …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... + 3+ years relevant experience, including: + 2 years previous experience as a Medical Director in a clinical practice. + Current clinical knowledge. + Experience… more
    Molina Healthcare (08/08/25)
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  • Medical Director - Florida

    Humana (Albany, NY)
    …and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
    Humana (07/29/25)
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  • Field Medical Director , Cardiology

    Evolent (Albany, NY)
    …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key... you will be a key member of the utilization management team. We can offer you a meaningful… more
    Evolent (08/15/25)
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  • Field Medical Director - Vascular…

    Evolent (Albany, NY)
    …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... **What You'll Be Doing:** As a Vascular Surgery, Field Medical Director you will be a key... you will be a key member of the utilization management team. We can offer you a meaningful… more
    Evolent (08/28/25)
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  • Field Medical Director , Pain…

    Evolent (Albany, NY)
    …per inter-rater reliability process. + On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall ... for the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer, Interventional Pain Management, you will be... management while working in conjunction with the Senior Medical Director . May assist the Senior … more
    Evolent (08/20/25)
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