- Centene Corporation (New York, NY)
- …and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review ... benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …II (in addition to Level I Qualifications) + Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge of ... you, we encourage you to apply! Job Description: The Medical Director participates in the broad array...decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests… more
- Evolent (Albany, NY)
- …new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as assigned mentor as ... Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a...Provides medical direction to the support services review process. Responsible for the quality of utilization… more
- Centene Corporation (New York, NY)
- … management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , ... perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
- Evolent (Albany, NY)
- …non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National...process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Humana (Albany, NY)
- …how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of moderately complex to complex ... management. + Utilization management experience in a medical management review organization, such as Medicare...on size of region or line of business. The Medical Director conducts Utilization Management… more
- 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... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- 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... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Albany, NY)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- 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