- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- CVS Health (Albany, NY)
- …with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management opportunity for RNs with a **New York** state licensure. ... to service requests. Works closely with leadership and Medical Director on member requests. This role is responsible to...unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of clinical experience… more
- Mount Sinai Health System (New York, NY)
- …: + Active RN license in the state of employment required + Certification in Case Management (CCM, ACM) or Utilization Management preferred. + 7+ years of ... **Job Description** ** Director Pre Appeals Management -HSO Appeals ...experience in clinical acute clinical, utilization management , appeals management or… more
- 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 (Albany, NY)
- …a Lead Medical Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Evolent (Albany, NY)
- …Clinical Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical… more
- Bassett Healthcare (Cooperstown, NY)
- …secures financial and human resources for the department. Oversees and works with the Director of Utilization Management to support and implement the goals ... director is responsible for the oversight of case management and logistics activities for the Bassett Healthcare Network...of the utilization management program. Maintains oversight responsibility for… more
- Pfizer (Albany, NY)
- …for specific contracts and communicate learnings across the Vaccine Account Management / National Account Director organizations to increase effectiveness. ... **ROLE SUMMARY** The National Vaccine Contracting Director (NVCD) will...KPIs include, but are not limited to, vaccine portfolio utilization , protocol development, contract closure and performance, peer and… more
- Centene Corporation (New York, NY)
- …New York + Board certified in Internal Medicine or Family Medicine + Utilization Management experience and knowledge of quality accreditation standards. + ... functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. +… more
- 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
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