• Medical Director, Commercial Line of Business

    Excellus BlueCross BlueShield (Rochester, NY)
    …Reviews and makes recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of ... review determinations. + Provides input into the utilization management program policies and procedures. +...Qualifications) + Minimum 2-3 years of experience in medical management , utilization review and case… more
    Excellus BlueCross BlueShield (12/29/25)
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  • Field Medical Director, Interventional Cardiology…

    Evolent (Albany, NY)
    …Stay for the culture. **What You'll Be Doing:** Job Description **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
    Evolent (12/18/25)
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  • Medical Director, Psychiatry (SafetyNet…

    Excellus BlueCross BlueShield (Buffalo, NY)
    …Accountabilities: Level I + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. ... Performs medical review activities pertaining to utilization review...expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory,… more
    Excellus BlueCross BlueShield (11/12/25)
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  • Field Medical Director, Cardiology

    Evolent (Albany, NY)
    …Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
    Evolent (12/31/25)
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  • Field Medical Director - Vascular Surgery

    Evolent (Albany, NY)
    …As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
    Evolent (10/10/25)
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  • Chief Medical Officer

    WMCHealth (Valhalla, NY)
    …of quality and cost improvement that is data driven and develops systems to review utilization of resources and measure outcomes of care. Monitors physician data ... + Works with leadership team to support clinical documentation integrity and utilization management at the Medical Center. Qualifications / Requirements: +… more
    WMCHealth (11/04/25)
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  • Senior Medical Director, Behavioral Health

    Molina Healthcare (NY)
    …contributing to enterprise-wide strategies for integrated behavioral health programs, utilization management standardization, and cost-effective quality outcomes ... multi-state region. + Provides psychiatric leadership and clinical expertise for utilization management , case management , and integrated behavioral… more
    Molina Healthcare (01/01/26)
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  • Nurse Case Manager: Full Time, DAYS

    Albany Medical Center (Albany, NY)
    …works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to ... assigned service - required + Recent experience in case management , utilization management and/or discharge...Basic knowledge of computer systems with skills applicable to utilization review process. + RN - Registered… more
    Albany Medical Center (12/06/25)
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  • Physician Advisor

    Mohawk Valley Health System (Utica, NY)
    …specialist regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... range of medical/clinical knowledge. + Expertise in, or willing to learn utilization management , state/federal regulations, private payer contracts. + Dedication… more
    Mohawk Valley Health System (10/07/25)
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  • Clinical Pharmacy Specialist, Pharmacy Benefits…

    Northwell Health (New Hyde Park, NY)
    …for the development, implementation, and maintenance of drug formularies, clinical utilization management (UM) criteria, and evidence-based drug therapy ... plans + Experience in formulary management , P&T committee support, and/or utilization management (PA, ST, QL) criteria development + Experience with benefit… more
    Northwell Health (12/23/25)
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