• Utilization Review Nurse I

    Centene Corporation (New York, NY)
    …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical ... appropriateness and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review … more
    Centene Corporation (08/02/25)
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  • Director of Case Management

    Stony Brook University (Stony Brook, NY)
    …design, development, implementation, and monitoring of the organization's case management and utilization review functions. + Lead initiatives to improve patient ... Director of Case Management **Position Summary** We are...and collaboration with Social Work Services * Knowledge of Utilization Review and Denial/Appeals * Knowledge of… more
    Stony Brook University (08/08/25)
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  • Medical Director (Marketplace)

    Molina Healthcare (Albany, NY)
    …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
    Molina Healthcare (08/08/25)
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  • Director of Nursing Professional Practice,…

    Mount Sinai Health System (New York, NY)
    …Description** The Director of Nursing Professional Practice is a professional nurse with broad knowledge and skill in the professional practice standards, NYS ... in the Daily Management Board process/practice improvement activities to facilitate the utilization of evidence and data related to Nurse Sensitive Indicators… more
    Mount Sinai Health System (07/15/25)
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  • Director of Care Coordination

    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...but not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals, Managed Care and Revenue Cycle… more
    Catholic Health Services (07/18/25)
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  • Medical Director

    STG International (Watertown, NY)
    …* Design and participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health enhancement ... STGi is currently seeking a Medical Director to provide services at our Community Based...and orientation of clinical staff physicians, physician assistants and nurse practitioners. * Collaborate with the CBOC Clinic Manager… more
    STG International (07/19/25)
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  • Medical Director

    STG International (Kingston, NY)
    …+ Design and participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health enhancement ... THIS IS FOR A FUTURE OPENING STGi is currently seeking a Medical Director to provide services at our Community Based Outpatient Clinic. JOB SUMMARY: The general duty… more
    STG International (07/09/25)
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  • VPS Psychiatric Nurse Practitioner

    City of New York (New York, NY)
    …The CAS Visiting Psychiatric Services (VPS) Unit is recruiting for two (2) Psychiatric Nurse Practitioner for the roles below. Under the supervision of the Medical ... Director and of the Mental Health Director ,...independent judgement within NYS licensing guidelines, the VPS Psychiatric Nurse Practitioner is responsible for performing psychiatric evaluations of… more
    City of New York (08/08/25)
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  • Director of Care Management - Mount Sinai…

    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 ... years of Case Management and 6 years of clinical nurse experience. Previous supervisory experience in Case Management or...services by focusing on patient processes. 8.Develops and implements Utilization Review (UR) based on internal data… more
    Mount Sinai Health System (07/24/25)
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  • Medical Director , Children's Services…

    Excellus BlueCross BlueShield (Buffalo, NY)
    …implementation of the Children's Behavioral Health (BH) Carve-In program. The Medical Director for BH Children's Services has overall accountability for BH services ... timely manner and provides support for the Case Management (CM) and Registered Nurse (RN) reviewers and manages the denial process. + Leads interdisciplinary complex… more
    Excellus BlueCross BlueShield (05/10/25)
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