• Behavioral Health Medical Director - Medicare

    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 (11/11/25)
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  • PCO Medical Director- UM - Full Time

    CenterWell (Albany, NY)
    …**Additional Information** Will report to the Director of Physician Strategy at Utilization Management . The Medical Director conducts Utilization review ... work, communication of decisions to internal associates, participation in care management and possible participation in care facilitation with hospitals. The… more
    CenterWell (11/06/25)
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  • Medical Services Coordination Specialist I/II/III

    Excellus BlueCross BlueShield (Rochester, NY)
    …Coordination Specialist provides administrative support for any of the programs of Utilization Management , Behavioral Health, Quality Management , or Member ... tasks under pressure. + Demonstrates proficiency in basic navigation and utilization of department specific applications: care management system, department… more
    Excellus BlueCross BlueShield (10/21/25)
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  • VP, Medical Economics

    Molina Healthcare (Yonkers, NY)
    …Tableau and data management . * Advanced understanding health care operations ( utilization management , disease management , HEDIS quality measures, claims ... tracking tools and identify opportunities to improve performance and data management , and support, guide and influence decision-making related to clinical programs,… more
    Molina Healthcare (11/21/25)
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  • Appeals Manager

    BronxCare Health System (Bronx, NY)
    …assist the department's leadership develop strategies for denial prevention, improved utilization management , documentation of medical necessity and identify ... of stay, avoidable day and barriers to discharge processes pertaining to utilization management . - Liaisons and coordinates with other hospital departments… more
    BronxCare Health System (11/15/25)
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  • Health Insur & Auth Rep III

    University of Rochester (Rochester, NY)
    …of Medicare and other payer regulations for the coordination of benefits. + Notify Utilization Management of clinical requests by third party payers. + Maintain ... Counseling, Medicaid Enrollment & Outreach, Financial Assistance, Registration and Insurance Management , Utilization Management , Social Work, Patient… more
    University of Rochester (10/14/25)
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  • Director of Care Coordination

    Crouse Hospital (Syracuse, NY)
    …as a Registered Professional Nurse in New York State. + Recent acute care Utilization Management and Case Management experience. + Current certification in ... support systems. Coordinates financial and budgetary acquisitions, allocations and utilization of resources needed for quality, cost-effective, program(s)/service(s). +… more
    Crouse Hospital (09/18/25)
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  • Case Manager, Medicaid Long Term Support Program

    MVP Health Care (Tarrytown, NY)
    …every interaction **Your key responsibilities:** + Utilize the essentials of an integrated utilization management and case management model that includes ... accreditation standards (eg, NCQA), including documentation and reporting. + Cost Management : Monitor service utilization to maintain cost-effectiveness and… more
    MVP Health Care (11/23/25)
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  • Broker II, Marine Cargo

    AON (New York, NY)
    …to collaborate effectively with others. + Experience in resource deployment and utilization management . + Successfully operates in a fast-paced driven ... to collaborate effectively with others. + Experience in resource deployment and utilization management . + Successfully operates in a fast-paced driven… more
    AON (11/21/25)
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  • Case Manager - AOMC

    Arnot Health (Elmira, NY)
    … of patient care . The Case Manager will review all patients for utilization management and appropriate discharge planning. The Case Manager's average caseload ... the guidelines. . Identifies the appropriate patients for Case Management services. . Maintains a working knowledge of the...The Case Manager tracks and trends LOS , resource utilization , outliers, readmissions , denials , delay days… more
    Arnot Health (11/06/25)
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