- CVS Health (New York, NY)
- …anywhere in the US.** Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Spine) that can be remote based, work from home. The ... Medical Director (Spine) will be a Subject...responses to members and providers. Leads all aspects of utilization review /quality assurance, directing case management Provides… more
- Evolent (Albany, NY)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... improving healthcare quality.** + **Computer proficiency** and ability to navigate electronic medical review platforms. + No current exclusions, sanctions, or… more
- Highmark Health (Albany, NY)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... and improve the care of our members **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may… more
- Merck (Albany, NY)
- **Job Description** **Role Summary:** The Sr. Global Director Medical Affairs (GDMA) is responsible for supporting the execution of scientific & medical ... educational or risk management) to support appropriate and safe utilization of Our Company medicines or vaccines. **Required Qualifications,...Decision Making, Empathy, Market Access, Medical Affairs, Medical Research, Medical Review , … more
- Catholic Health Services (West Islip, NY)
- …with Hospital Conditions of Participation. Implements care management programs, including utilization review , intake and discharge planning. Evaluates patient ... Overview The Director of Care Management is responsible for providing...Care Management: Works collaboratively with, but not limited to, Medical Staff, Quality/Risk Management, CH Utilization and… more
- Travelers Insurance Company (Albany, NY)
- …influences which can impact claim outcomes. Organize and coordinate Travelers' medical review functions. This includes interpreting Federal and State ... regulations and medical guidelines to establish medical ...Have?** + Licensed MD + 5 years clinical and utilization management experience + Certified by the American Board… more
- Sunrise Senior Living (Mount Vernon, NY)
- …NAME** Sunrise at Fleetwood **Job ID** 2025-229230 **JOB OVERVIEW** The Executive Director is responsible for overall leadership, management, and success of the ... and services to seniors better than anyone. The Executive Director creates, in alignment with our mission and values,...achieving customer engagement. + Lead the development and regular review of the engagement improvement plan. + Resolve customer… more
- STG International (West Seneca, NY)
- …safety. + Participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health enhancement ... of the Primary Care Physician is to provide covered professional outpatient primary medical services to enrolled patients of the Veterans Affairs Medical Center… more
- BAE Systems (Endicott, NY)
- …that we support: https://www.baesystems.com/en-us/capability/avionics BAE Systems is seeking a Director of Program Quality Engineering, reporting to the Sr. ... Director of Quality of the Controls and Avionics Solutions...of program quality engineers to accomplish the following: + Review and assess customer/contractual quality requirements for compliance and… more
- Mount Sinai Health System (Long Island City, NY)
- …The Director will direct and manage departmental activities involved in utilization review , appeals management and discharge planning to facilitate the case ... to influence other services by focusing on patient processes. 8.Develops and implements Utilization Review (UR) based on internal data collection, data received… more