• Behavioral Health Medical Director-Psychiatrist…

    Elevance Health (New York, NY)
    …and Experiences:** + Child and Adolescent experience strongly preferred. + Utilization Management experience. + Applied Behavior Analysis (ABA) experience. ... and/or independently performs clinical reviews. + Typically has program management responsibilities including clinical policy development, improvement of quality,… more
    Elevance Health (09/10/25)
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  • Medical Claim Review Nurse (RN)

    Molina Healthcare (Rochester, NY)
    …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review. + Minimum two years of experience in… more
    Molina Healthcare (09/06/25)
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  • Health Home Care Manager

    University of Rochester (Rochester, NY)
    …results received and acted upon as needed + Document plan of care, patient utilization , care management activities and other required information in state and ... and internal equity considerations._ **Responsibilities:** Provides professional comprehensive care management services to patients of the Strong Memorial Hospital,… more
    University of Rochester (09/06/25)
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  • Director, Univera Contracting, Analytics & Value…

    Excellus BlueCross BlueShield (Buffalo, NY)
    …on pricing points for all products and will act as a liaison with Utilization Management , Care Management and Actuarial/Finance to ensure appropriate ... with corporate strategic objectives including population health contracting, contract management , operations processes and government reimbursement trends. Oversees contracting… more
    Excellus BlueCross BlueShield (09/11/25)
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  • Vice President, Strategic Accounts

    Evolent (Albany, NY)
    …opportunities at customer accounts + Strong knowledge of health plan operations, care/ utilization management , claims processing, value-based care, and the levers ... client and organizational objectives. **What You Will Be Doing:** **Account/ Relations Management ** - provide corporate, executive and overall account management … more
    Evolent (08/27/25)
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  • Case Manager at St Peters Hospital - All Shifts…

    Trinity Health (Albany, NY)
    …experience in acute setting **Preferred requirements:** + 1+ year of experience in case management or utilization management + Case Management ... Engage the patient and care team in the joint management of key patient outcomes such as management of disease progression, continued LOS and transition to most… more
    Trinity Health (07/18/25)
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  • VP & Medical Director

    Travelers Insurance Company (Albany, NY)
    …skills **What is a Must Have?** + Licensed MD + 5 years clinical and utilization management experience + Certified by the American Board of Medical Specialties ... to keep Travelers at the leading edge of the P&C industry. Develop medical management strategies that help injured employees return to work as soon as medically… more
    Travelers Insurance Company (07/25/25)
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  • Registered Nurse Case Manager

    Northwell Health (Sleepy Hollow, NY)
    …+ Facilitates patient management throughout hospitalization. + Performs concurrent utilization management using evidence based medical necessity criteria. + ... Submits data to management regarding case management and/or quality initiatives. + Serves as an in-patient liaison - planning, assessing, implementing and… more
    Northwell Health (09/29/25)
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  • Senior Provider Relations Representative

    Molina Healthcare (Buffalo, NY)
    …example, such meetings would occur to discuss and resolve issues related to utilization management , pharmacy, quality of care, and correct coding. * ... and contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability… more
    Molina Healthcare (09/25/25)
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  • Registered Nurse Case Manager (RN Case Manager)…

    Northwell Health (Staten Island, NY)
    …+ Facilitates patient management throughout hospitalization + Performs concurrent utilization management using evidence based medical necessity criteria + ... Submits data to management regarding case management and/or quality initiatives + Serves as an in-patient liaison - planning, assessing, implementing and… more
    Northwell Health (09/17/25)
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