• Sumer 2026 Analytic Enablement Graduate Intern

    Highmark Health (Albany, NY)
    …AI techniques, assessing their applicability to core healthcare payer operations (eg, utilization management , claims processing, member services). 3. Modeling & ... **Company :** Highmark Health **Job Description :** **SUMMARY OF JOB RESPONSIBILITIES**...position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
    Highmark Health (10/28/25)
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  • VP, Clinical Operations

    Molina Healthcare (Buffalo, NY)
    …State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... plan and coordinate an integrated delivery of care across the continuum, including physical health and behavioral health , for members with high need… more
    Molina Healthcare (10/26/25)
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  • Integrated Outpatient Senior Clinician

    FLACRA (Penn Yan, NY)
    …progress notes and other documentation required for the client medical record and utilization management within the timelines outlined by FLACRA. + Participates ... + Monitors, support, and mentors clinicians in their practice management to meet expectations for excellent client care. +...staff and community service providers. + Knowledge of local behavioral health service system. + Ability to… more
    FLACRA (11/11/25)
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  • AVP of OR/Peri-Op Services

    Albany Medical Center (Albany, NY)
    …short- and long-term goals and objectives. As a member of the nursing executive management team, the AVP participates in the efficient and effective management ... development of its strategic plan. Education: + A Master's Degree in health , business, education or related field. Licensure, Certification & Registration: + Must… more
    Albany Medical Center (09/27/25)
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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 ... a focus on collaborative business relationships, value-based care, population health , or disease or care management . **Use...and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral … more
    CenterWell (11/06/25)
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  • Social Worker II

    Ellis Medicine (Schenectady, NY)
    …implement and evaluate individual healthcare needs. Integrate Discharge Planning, Utilization Review and Performance Improvement activities at the patient, hospital ... levels. Efficiently and effectively anticipates, identifies and resolves issues through utilization review and discharge planning processes. Collaborates with the ED… more
    Ellis Medicine (09/23/25)
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  • Associate Clinical Director

    Villa of Hope (Rochester, NY)
    …Tuckahoe Community Residence (Williamson Location) SUPERVISOR: Clinical Director of Behavioral Health Residential, School, & LHTC FLSA: Exempt ... Under the general direction of the Clinical Director of Behavioral Health Residential, School, & LHTC, the...they may enroll in at Villa of Hope (Clinic, Health Homes/Care Management , etc.). The Director operates… more
    Villa of Hope (11/19/25)
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  • Senior Value-Based Programs Professional

    Humana (Albany, NY)
    …+ Administers new innovative VBP models for range of provider types, such as behavioral health , maternity, specialists, and social determinants of health , ... part of our caring community and help us put health first** Humana Healthy Horizons is seeking a Senior...move providers from volume to value. + Analyzes financial, utilization , and performance data to identify opportunities to drive… more
    Humana (11/11/25)
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  • Care Review Clinician, PA (RN)

    Molina Healthcare (Rochester, NY)
    …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. ... Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.… more
    Molina Healthcare (10/26/25)
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  • Psychiatrist - Inpatient

    St. Mary's Healthcare (Amsterdam, NY)
    …seeking a dedicated Inpatient Psychiatrist to join our compassionate and experienced Behavioral Health team in Amsterdam, NY. This full-time, hospital-employed ... patient-centered care. St. Mary's is committed to improving access to integrated behavioral health services across Fulton/Montgomery County and the surrounding… more
    St. Mary's Healthcare (11/07/25)
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