• Asst Utilization Coordinator

    WMCHealth (Valhalla, NY)
    …the implementation or investigation of the procedures specified in the Quality Management , Utilization Review and Discharge Planning Program at Westchester ... of which must have been in the area of utilization review, quality assurance, risk management or...area of utilization review, quality assurance, risk management or discharge planning. About Us: Westchester Medical Center… more
    WMCHealth (09/12/25)
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  • Assistant Director of Case Management

    Stony Brook University (Stony Brook, NY)
    …the following but are not limited to:** + Responsible for addressing Utilization management , denials and appeal, discharge and transition planning activities, ... Case Management leadership and staff functions regarding care management and utilization management activities. + Manages human resources utilization… more
    Stony Brook University (09/23/25)
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  • RN Acute Case Manager - System Care…

    Guthrie (Binghamton, NY)
    …recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with ... inpatient admissions and short procedures by translating clinical information to Utilization Management requirements using pre‐determined criteria. b. Documents… more
    Guthrie (08/27/25)
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  • Pharmacist, Clinical/Medication Therapy…

    Molina Healthcare (Syracuse, NY)
    …track general trends in drug utilization and identify potential targeted utilization management activities. * Works with healthcare services team (eg, data ... authorization requests as needed. * Researches, develops, and implements drug utilization and disease state management strategies and intervention techniques… more
    Molina Healthcare (09/24/25)
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  • Field Medical Director, Pain Management

    Evolent (Albany, NY)
    …Clinical Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical… more
    Evolent (09/25/25)
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  • Medical Director - Claims Management

    Humana (Albany, NY)
    …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
    Humana (09/17/25)
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  • Case Management Associate

    Ellis Medicine (Schenectady, NY)
    …CMS Conditions of Participation at the direction of the Case Manager. * Utilization Management Activities; Collaborates with Case Managers and other team members ... for optimal Utilization Management information throughout the continuum. Maintains relationships with payers and communicates confidential information per… more
    Ellis Medicine (09/11/25)
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  • Medical Director

    Centene Corporation (New York, NY)
    …New York + Board certified in Internal Medicine or Family Medicine + Utilization Management experience and knowledge of quality accreditation standards. + ... functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. +… more
    Centene Corporation (09/07/25)
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  • VP Care Management Post-Acute Care…

    Kaleida Health (Buffalo, NY)
    …Business field preferred. RN licensure required.** **Experience** **10 years of care management / utilization management experience required in hospital and/or ... **VP Care Management Post-Acute Care Transition** **Location:** **Buffalo General Medical...daily oversight of operations, the VP will partner with Utilization Review, Revenue Cycle, and Clinical leadership to create… more
    Kaleida Health (09/17/25)
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  • Medical Director, Commercial Line of Business

    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 ... State and Federal Mandates and maintains current and working knowledge of Utilization Management Standards. + Clinical skills are excellent and evidence-based… more
    Excellus BlueCross BlueShield (09/30/25)
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