• National Vaccine Contracting Director (VCM)

    Pfizer (Albany, NY)
    …to, national integrated delivery networks (IDNs), national and regional payers, physician buying groups (PBGs), group purchasing organizations (GPOs) and specialty ... also work closely with the iVCM team/Senior Director to review opportunities at the PBG member level and with...KPIs include, but are not limited to, vaccine portfolio utilization , protocol development, contract closure and performance, peer and… more
    Pfizer (10/31/25)
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  • Director, Care Coordination

    Northwell Health (Mount Kisco, NY)
    …RN Case Management and Social Work Services team. Develops processes to monitor utilization review inclusive of length of stay (LOS) and resource reduction ... facility best practices and makes recommendations for process improvement. Oversees resource utilization for the hospital and provides specific data analysis on … more
    Northwell Health (10/30/25)
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  • Director-Care Mgmt

    Catholic Health Services (Roslyn, NY)
    …and monitors staff satisfaction. + Assures compliance with regulatory and external review agencies. + Participates in the Utilization Management Committee, ... reporting data on utilization trends, resource utilization and denials. + Serves as a resource to...and denials. + Serves as a resource to physicians, physician advisors, CM department, and hospital staff. + Collaborates… more
    Catholic Health Services (10/10/25)
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  • Nurse Case Manager - FT Days

    Nuvance Health (Poughkeepsie, NY)
    …Nursing, BSN preferred. Must have current RN license. *Preferred Experience: * Utilization Review /Management.Company: Vassar Brothers Medical Center Org Unit: ... Medical Center in New York - plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology… more
    Nuvance Health (09/28/25)
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  • Medical Director - Claims Management

    Humana (Albany, NY)
    …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
    Humana (11/01/25)
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  • Medical Director - Medicaid Team - FL/SC

    Humana (Albany, NY)
    …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of all… more
    Humana (10/28/25)
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  • Medical Director - Medicaid N. Central

    Humana (Albany, NY)
    …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
    Humana (10/25/25)
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  • Clinical Denials and Appeals-Clinical Supervisor

    Catholic Health (Buffalo, NY)
    …(the payers) and internal stakeholders including, but not limited to, Utilization Review , Case Management, Clinical Documentation Integrity, Health Information ... Management, Physicians and Physician leadership, Finance, Information Technology and other Clinical stakeholders....approved by management + Certification in a Nationally Recognized Utilization Review Criteria set is preferred EXPERIENCE… more
    Catholic Health (10/01/25)
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  • Field Reimbursement Manager - New York Metro

    Amgen (New York, NY)
    …HUB, providing live one-on-one coverage support + Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer ... prior authorization to appeals/denials requirements and forms + Review patient-specific information in cases where the site has specifically requested assistance… more
    Amgen (10/02/25)
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  • Medical Policy Coordinator

    Excellus BlueCross BlueShield (Rochester, NY)
    …+ In collaboration with the Lead Medical Policy Coordinators, tracks the annual review requirements of assigned policies ensuring all annual reviews are completed in ... for both new policy development and for the annual review of assigned policies. + Conducts research on best...for data analysis of assigned medical policies assessing the utilization and cost effectiveness for their assigned policy. This… more
    Excellus BlueCross BlueShield (10/29/25)
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