- MVP Health Care (Rochester, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Medical Director , Post-Acute Care Utilization Management** to join #TeamMVP. If you ... authorizations for Post-Acute Care requests additional involvement in adjudicating pharmacy , prospective, concurrent and retrospective prior authorization requests for… more
- University of Rochester (Rochester, NY)
- …individual, and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE: The Senior Director , Ambulatory Pharmacy Services is responsible for the ... operations management, clinical services, pharmacy data analytics, and pharmacy procurement/inventory management. The Senior Director , Ambulatory Pharmacy… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Senior Director of Information Technologies is responsible for planning designing and implementing information systems and technologies for ... support drug procurement, storage, dispensing, admixture, and management, as well as the Pharmacy data warehouse. This would include but not limited to Pyxis, IV… more
- Humana (Albany, NY)
- …a part of our caring community and help us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). ... The Medical director work assignments involve moderately complex to complex issues...National and Local Coverage Determinations, CMS-recognized Compendia, NCCN, Humana Pharmacy Policies and Procedures, and clinical literature as appropriate.… more
- CenterWell (Albany, NY)
- …part of our caring community and help us put health first** The National Director , Care Integration Strategy & Program will be responsible for the end-to-end program ... will play a pivotal role in reducing acute care utilization for top 5% of complex patients and ensuring...reduction, and other clinical programs as determined. The National Director , Care Integration Strategy & Program is a critical… more
- Albany Medical Center (Albany, NY)
- …States of America) Salary Range: $65,102.17 - $100,908.37 Under the direction of the Director of Pharmacy the Pharmacy Revenue Integrity Auditor will serve ... processes. They are responsible for ensuring the accuracy and compliance of pharmacy billing practices by reviewing patient records, medication orders, and insurance… more
- Centene Corporation (New York, NY)
- …York + Board certified in Internal Medicine or Family Medicine + Utilization Management experience and knowledge of quality accreditation standards. + Actively ... practices medicine **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …of the Medical Services area including, but not limited to, Medical and Pharmacy Utilization Management, quality management, member care management, and medical ... Level I + Reviews and makes recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include:… more
- Molina Healthcare (Syracuse, NY)
- …and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective ... resource management. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient… more
- Kelly Services (Rochester, NY)
- **Kelly(R) is looking for a Pharmacy Prior Authorization Technician to work at a top insurance client in the Rochester, NY area. Let us help you grow at work and ... weekend beginning no later than January 2026 **Summary Description** The Pharmacy Prior Authorization Technician performs initial-level processing and review of… more