- Humana (Albany, NY)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex ... management. + Utilization management experience in a medical management review organization, such as Medicare...on size of region or line of business. The Medical Director conducts Utilization Management… more
- Humana (Albany, NY)
- …care management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and ... operations team and healthcare organization. The Medical Director 's work includes computer based review of...management + Utilization management experience in a medical management review organization, such as Medicare… more
- Humana (Albany, NY)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... caring community and help us put health first** The Medical Director relies on medical ...management. + Utilization management experience in a medical management review organization, such as Medicare… more
- Evolent (Albany, NY)
- …timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Albany, NY)
- …timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Centene Corporation (New York, NY)
- …management, cost containment, and medical quality improvement activities. + Perform medical review activities pertaining to utilization review , ... with respect to clinical issues and policies. + Identify utilization review studies and evaluates adverse trends... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …the Quality Management/ Utilization Management (QM/UM) Plan, including having the BH Medical Director for Children's Services and participate on the BH ... of the Children's Behavioral Health (BH) Carve-In program. The Medical Director for BH Children's Services has...standards and issue. + Ensures that other Behavioral Health medical directors reviewing pediatric cases review those… more
- Stony Brook University (Stony Brook, NY)
- …design, development, implementation, and monitoring of the organization's case management and utilization review functions. + Lead initiatives to improve patient ... Director of Case Management **Position Summary** We are...and collaboration with Social Work Services * Knowledge of Utilization Review and Denial/Appeals * Knowledge of… more
- STG International (Watertown, NY)
- STGi is currently seeking a Medical Director to provide services at our Community Based Outpatient Clinic. JOB SUMMARY: The general duty of the Medical ... conditions of the Veteran Affairs Primary Care Program. The Medical Director will also collaborate with the...participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes,… more
- STG International (Kingston, NY)
- THIS IS FOR A FUTURE OPENING STGi is currently seeking a Medical Director to provide services at our Community Based Outpatient Clinic. JOB SUMMARY: The general ... duty of the Medical Director is to provide oversight for...participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes,… more