• Nurse Practitioner - Klingenstein 3 NICU - Mount…

    Mount Sinai Health System (New York, NY)
    …interprets the clients responses to the plan of care. 11. Performs a patient record review with the collaborating physician in a timely fashion but not less than ... to established standards as part of initial orientation and annual performance review with collaborating physician or appropriately credentialed designee. 4.… more
    Mount Sinai Health System (09/26/25)
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  • Medical Director, Commercial Line of Business

    Excellus BlueCross BlueShield (Rochester, NY)
    …recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range ... of Medicine or Doctor of Osteopathic Medicine. + The Physician is not the subject of any pending professional...+ Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge… more
    Excellus BlueCross BlueShield (09/30/25)
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  • RN Acute Case Manager - System Care Management…

    Guthrie (Binghamton, NY)
    …years of experience in an acute care setting with strong care management, utilization review , and payer knowledge. A Case Management certification or obtaining ... of the healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria. b) Educates the physician and… more
    Guthrie (08/27/25)
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  • Medical Director

    Molina Healthcare (Rochester, NY)
    …and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource ... management. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care,… more
    Molina Healthcare (10/22/25)
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  • Medical Director (AZ)

    Molina Healthcare (NY)
    …and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource ... management. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care,… more
    Molina Healthcare (10/17/25)
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  • Field Medical Director, Pain Management

    Evolent (Albany, NY)
    … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... for the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer, Interventional Pain Management, you will be...Management, you will be a key member of the utilization management team. We can offer you a meaningful… more
    Evolent (09/25/25)
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  • Denials and Appeals Mngmt Cord

    WMCHealth (Valhalla, NY)
    …the results. + Maintains familiarity with the laws, regulations, and interpretation of utilization review and discharge planning. Remains up to date on changes ... Denials and Appeals Mngmt Cord Company: WMC Advanced Physician Services PC City/State: Valhalla, NY Category: Clerical/Administrative Support Department: Clinical… more
    WMCHealth (10/17/25)
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  • Nurse Practitioner - Crescent CVI - Mount Sinai…

    Mount Sinai Health System (Long Island City, NY)
    …interprets the clients responses to the plan of care. 11. Performs a patient record review with the collaborating physician in a timely fashion but not less than ... to established standards as part of initial orientation and annual performance review with collaborating physician or appropriately credentialed designee. +… more
    Mount Sinai Health System (10/29/25)
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  • Field Medical Director, Radiology (Neurology)

    Evolent (Albany, NY)
    … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Radiology you will be a key member of the utilization management team. We can offer you a meaningful...and management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will… more
    Evolent (10/31/25)
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  • Field Medical Director, Oncology

    Evolent (Albany, NY)
    … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Oncology, you will be a key member of the utilization management team. We can offer you a meaningful...and management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will… more
    Evolent (08/19/25)
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