• Commercial Review Specialist I

    SUNY Upstate Medical University (Syracuse, NY)
    …including PC, Windows, Microsoft applications, Zoom/WebEx platforms, etc. Preferred Qualifications: Utilization management or utilization review experience, ... Job Summary: The UR-CR Specialist I is primarily responsible for ensuring that...reimbursement entities. This is achieved through a thorough chart review and utilization of first-level screening criteria… more
    SUNY Upstate Medical University (11/18/25)
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  • Physician Advisor

    Mohawk Valley Health System (Utica, NY)
    … regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... billing status, and potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of...and quality patient care while ensuring effective and efficient utilization of resources. The Physician Advisor guides… more
    Mohawk Valley Health System (10/07/25)
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  • Healthcare Clinical Documentation…

    Deloitte (New York, NY)
    …nurse, physician , physician assistant, case manager, clinical documentation specialist , utilization review , informatics RN, Quality, DRG Validation ... Healthcare Clinical Documentation Specialist - Senior Consultant Our Deloitte Regulatory, Risk...for physicians, CDI team and ancillary staff and assist physician champion to conduct education as needed + Train… more
    Deloitte (11/21/25)
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  • Sr. Clinical Specialist - New York…

    J&J Family of Companies (New York, NY)
    …**Job Description:** We are searching for the best talent for Sr. Clinical Specialist to be in New York City/Northern New Jersey area. **About Surgery** Fueled ... Learn more at https://www.jnj.com/medtech **Core Job** **Responsibilities:** + The Clinical Specialist reports to the Regional Sales Manager (RSM) and is responsible… more
    J&J Family of Companies (12/09/25)
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  • Clinical Denials & Appeals Specialist

    Northwell Health (Melville, NY)
    …level of care decisions and billing status and ensures compliance with the Utilization Review standard and regulations. + Performs concurrent and retrospective ... Responsibility + Serves as liaison between the patient and facility/ physician and the third party payer. + Prepares and...4+ years preferred. + Prior Acute Case Management and/or Utilization Review experience, preferred. + Must have… more
    Northwell Health (12/06/25)
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  • Rare Disease Hemophilia Account Specialist

    Pfizer (Albany, NY)
    …patients. **What You Will Achieve** The Rare Disease Hemophilia Account Specialist (HAS) is the lead commercial customer-facing representative for Pfizer's ... team, to address customer educational needs and facilitate the appropriate utilization of Pfizer's innovative therapies for the hemophilia population. Pfizer's… more
    Pfizer (12/03/25)
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  • Clinical Support Specialist

    CDPHP (Latham, NY)
    …for a rewarding career. Established in 1984, CDPHP is a physician -founded, member-focused, and community-based not-for-profit health plan that offers high-quality ... invites you to be a part of that experience. The clinical support specialist (CSS) provides administrative support to clinical staff within Member Health. The CSS… more
    CDPHP (10/05/25)
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  • Clinical Pharmacy Specialist - Transplant

    Northwell Health (Manhasset, NY)
    …and provide pharmacy recommendations + Education and development of nurse, physician and pharmacy staff development pertaining to transplant and immunosuppression. + ... and research. + Develops and monitors the hospital's policies/procedures regarding utilization of medications in collaboration with the medical staff, Pharmacy, and… more
    Northwell Health (11/02/25)
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  • Primary Care Physician (PCP)

    STG International (Kingston, NY)
    …safety. + Participates 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 Primary Care Physician to provide services at our Community Based Outpatient Clinic. JOB SUMMARY: The… more
    STG International (10/08/25)
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  • Primary Care Physician (PCP) - PRN

    STG International (Auburn, NY)
    …safety. * Participates in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health enhancement ... STGi is currently seeking a Primary Care Physician to provide services at our Community Based...Performance Improvement Team (QPIT) strategic initiatives. * Participate in review and improvement of clinical success in of areas… more
    STG International (09/26/25)
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