• Medical Director - Cardiology

    Elevance Health (New York, NY)
    …state mandated policies, and CMS Coverage Determinations, as applicable. + Perform physician -level case review of utilization requests for procedures ... reviews for their board certified specialty. + Makes physician to physician calls to gather medical...necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director… more
    Elevance Health (07/02/25)
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  • Medical Director, Commercial Line of Business

    Excellus BlueCross BlueShield (Rochester, NY)
    …case reviews and may require peer-to-peer discussions with providers regarding UM case review determinations. + Provides clinical expertise on ARD cases, ... and may require peer-to-peer discussions with providers regarding UM case review determinations. + Provides input into...of Medicine or Doctor of Osteopathic Medicine. + The Physician is not the subject of any pending professional… more
    Excellus BlueCross BlueShield (07/01/25)
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  • Medical Director, Children's Services (SafetyNet…

    Excellus BlueCross BlueShield (Buffalo, NY)
    …reviews and peer-to-peer calls in timely manner and provides support for the Case Management (CM) and Registered Nurse (RN) reviewers and manages the denial process. ... rounds. + Provision of clinical oversight and leadership to Utilization Management/ Case Management (UM/CM) staff working with the children's population. + Develops,… more
    Excellus BlueCross BlueShield (05/10/25)
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  • Single Point of Access Program Associate

    CCSI INC (Johnson City, NY)
    …This includes communication with partnering agencies, coordination and facilitation of complex case review sessions and partnering with existing Department staff ... and assist with the facilitation of SPOA Committee meetings. + Document and track case statuses and progress while under the supervision of SPOA. + Develop and… more
    CCSI INC (07/23/25)
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  • Psychology - Mount Sinai Adolescent Health Center…

    Mount Sinai Health System (New York, NY)
    …MSAHC guaranteeing adherence to all aspects of clinical service delivery, reporting, incident review , and high-risk case management + Knowledge of and ability to ... of interest and send CV with Cover Letter to:** ** Physician Recruitment Department** **Mount Sinai Health System** **###@mountsinai.org** **Responsibilities**… more
    Mount Sinai Health System (07/25/25)
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