- Evolent (Albany, NY)
- …Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director . + Appropriately identifies potential ... opportunity to make a meaningful impact by providing exceptional support to internal and external customers through positive interactions, and timely delivery of… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …the Quality Management/Utilization Management (QM/ UM ) Plan, including having the BH Medical Director for Children's Services and participate on the BH ... of the Children's Behavioral Health (BH) Carve-In program. The Medical Director for BH Children's Services has...clinical setting). + A minimum of ten (10) years medical experience and strong working knowledge of QM/ UM… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …you see is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical ... reviews and may require peer-to-peer discussions with providers regarding UM case review determinations. + Provides clinical expertise on...and medical criteria. + Assists with training medical director colleagues and nursing staff ,… more
- CVS Health (Albany, NY)
- …Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical ... and consistent responses to members and providers. As a Medical Director you will focus primarily on...UM (Utilization Management) experience *Active and current state medical license without encumbrances *M.D. or DO, Board Certification… more
- Catholic Health Services (Melville, NY)
- …Minimum Qualifications: 1. Minimum Education/Training Required: Graduate of an accredited medical school. Completion of specialty residency (ie, Internal ... the monthly Physician Advisor meeting. Attends hospital Utilization Management ( UM ) committees. Supervises the Facility Physician Advisors. Observes Catholic Health… more
- Independent Health (Buffalo, NY)
- … medical necessity decision; and preparing request for review by assigned medical director , as needed. + Perform utilization of behavioral health (BH) ... services for members, ensuring compliance with internal and external standards set by regulatory and accreditation...and accreditation entities. + Refer appropriate cases to the Medical Director for review and work closely… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …all mandatory trainings as required.* May be required to attend Fair Hearings with Medical Director relating to specific cases.* Works independently, as well as ... Community Health Assessment (CHA) Tools to determine functional status, medical , behavioral, psychological, and community resource needs for coordinating,… more
- WMCHealth (Valhalla, NY)
- …and problems. + Participates in daily review of aggregate denials/appeals with the Medical Director , peer, or the Clinical Review Supervisor. + Provides ... Hiring Range: $257,702-$326,205 Apply Now External Applicant link (https://pm.healthcaresource.com/cs/wmc1/#/preApply/29449) Internal Applicant link Job Details: Job Summary: The Physician… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director , Pharmacist, Geriatrics, etc.) to ensure continuity ... to the department, either by data analysis or by internal or external referral sources. Applies case management criteria...Certification required + Broad understanding of multiple areas (ie UM and CM). At this level, incumbent is required… more
Recent Jobs
-
Mental Health Worker II
- State of Maine, Bureau of Human Resources (Augusta, ME)
-
Pet Care Assistant
- Banfield Pet Hospital (Richfield, MN)
-
Medical Assist II, Certified - Pediatrics at Weaver Crossing
- UNC Health Care (Chapel Hill, NC)
-
Children's Mental Health and Wellness - Cftss Olp Intern (Unpaid)
- Family and Children's Association (Mineola, NY)