• Medical Director , Post-Acute Care…

    MVP Health Care (Rochester, NY)
    …thinking and continuous improvement. To achieve this, we're looking for a **Medical Director , Post-Acute Care Utilization Management ** to join #TeamMVP. If ... reviews, continued stay requests, and handling first-level appeals. + Collaborate with Utilization Management , Case Management , Quality Department and other… more
    MVP Health Care (08/11/25)
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  • Utilization Review Nurse I

    Centene Corporation (New York, NY)
    …and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a ... for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering… more
    Centene Corporation (08/02/25)
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  • Medical Director - National Medicare

    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 in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (07/21/25)
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  • Director of Case Management

    Stony Brook University (Stony Brook, NY)
    …including managing Case Management leadership and staff functions related to case management and utilization management activities. + Manage and mentor a ... Director of Case Management **Position Summary**...design, development, implementation, and monitoring of the organization's case management and utilization review functions. + Lead… more
    Stony Brook University (08/08/25)
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  • Medical Director , Commercial Line…

    Excellus BlueCross BlueShield (Rochester, NY)
    …of the Medical Services area including, but not limited to, Medical and Pharmacy Utilization Management , quality management , member care management , and ... State and Federal Mandates and maintains current and working knowledge of Utilization Management Standards. + Clinical skills are excellent and evidence-based… more
    Excellus BlueCross BlueShield (07/01/25)
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  • Assistant Director - Management

    City of New York (New York, NY)
    …TASK FORCE: Management & Operations JOB TITLE: One (1) Assistant Director of Management and Operations CONTROL CODE: MOT-24-01 Summary: The Mayor's ... a more streamlined and responsive city government. Job Description: The Assistant Director of Management and Operations will provide leadership, strategic… more
    City of New York (06/11/25)
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  • Remote Medical Director

    Centene Corporation (New York, NY)
    …functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. + ... Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate,… more
    Centene Corporation (07/03/25)
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  • Director , Division Of Space…

    City of New York (New York, NY)
    …initiatives, and the implementation of integrated systems that govern real estate asset management and space utilization . The Director leads a profession ... Space and Design, and with wide latitude for independent judgment and initiative, the Director of the Division of Space Management (DSM) oversees all technical… more
    City of New York (08/01/25)
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  • Medical Director , MSK Surgery

    Evolent (Albany, NY)
    …classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as ... for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of...reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with… more
    Evolent (05/20/25)
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  • Field Medical Director , Interventional…

    Evolent (Albany, NY)
    …impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
    Evolent (07/30/25)
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