• Behavioral Health Medical Director…

    Humana (Albany, NY)
    …care management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and ... operations team and healthcare organization. The Medical Director 's work includes computer based review of...management + Utilization management experience in a medical management review organization, such as Medicare… more
    Humana (08/09/25)
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  • Medical Director - NorthEast Region

    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 ... caring community and help us put health first** The Medical Director relies on medical ...management. + Utilization management experience in a medical management review organization, such as Medicare… more
    Humana (07/25/25)
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  • Field Medical Director , Pain…

    Evolent (Albany, NY)
    … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure...process. + On a requested basis, may function as Medical Director for selecting health plans or… more
    Evolent (08/20/25)
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  • Medical Director -Pharmacy Appeals

    Humana (Albany, NY)
    …part of our caring community and help us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & ... and medical necessity. The Medical Director 's work includes computer based review of...management + Utilization management experience in a medical management review organization such as Medicare… more
    Humana (08/22/25)
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  • Field Medical Director , Oncology

    Evolent (Albany, NY)
    …timely and accurate manner. . 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 , Oncology, you will be a... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
    Evolent (08/19/25)
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  • Medical Director

    Elevance Health (New York, NY)
    ** Medical Director ** _Please note that per...state or territory of the United States when conducting utilization review or an appeals consideration and ... for employment, unless an accommodation is granted as required by law._ The ** Medical Director ** is responsible for the administration of physical and/or… more
    Elevance Health (08/23/25)
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  • Field Medical Director , Physical…

    Evolent (Albany, NY)
    …timely and accurate manner. + 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 , Physical Medicine and Rehab you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
    Evolent (07/24/25)
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  • Senior Child Behavioral Medical…

    Centene Corporation (New York, NY)
    …management, cost containment, and medical quality improvement activities. + Perform medical review activities pertaining to utilization review , ... with respect to clinical issues and policies. + Identify utilization review studies and evaluates adverse trends... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
    Centene Corporation (08/08/25)
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  • Field Medical Director , Radiology…

    Evolent (Albany, NY)
    …timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
    Evolent (08/02/25)
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  • Medical Director , Children's…

    Excellus BlueCross BlueShield (Buffalo, NY)
    …the Quality Management/ Utilization Management (QM/UM) Plan, including having the BH Medical Director for Children's Services and participate on the BH ... of the Children's Behavioral Health (BH) Carve-In program. The Medical Director for BH Children's Services has...standards and issue. + Ensures that other Behavioral Health medical directors reviewing pediatric cases review those… more
    Excellus BlueCross BlueShield (08/09/25)
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