• Director Medical Affairs Operations-Medical Staff…

    Mount Sinai Health System (New York, NY)
    **Job Description** **Director Medical Affairs Operations-Medical Staff Services - Full -Time -Days (Remote)** _Our flexible remote opportunities offer an excellent ... the system on all matters related to medical staff governance, credentialing, peer review and performance management; + In collaboration with the FPA, Development of… more
    Mount Sinai Health System (10/19/25)
    - Related Jobs

  • RN Case Manager

    Stony Brook University (Stony Brook, NY)
    …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...patients who were readmitted within thirty days. Documents over utilization of resources and services. + All Medicare cases… more
    Stony Brook University (10/23/25)
    - Related Jobs

  • RN Clinical Manager

    CenterWell (Westbury, NY)
    …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... and help us put health first** **Work Schedule** : Full -time/40 Hours **Position Type** : On-site **Branch Location** :...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more
    CenterWell (09/30/25)
    - Related Jobs

  • Bone Marrow Transplant (BMT) Cellular Therapy…

    Mount Sinai Health System (New York, NY)
    …Therapy Program Manager (RN/NP) - Outpatient Oncology - Mount Sinai Hospital - Full Time - Day** The program manager is responsible for coordination, and throughput ... 4. Reviews and performs patient service recovery 5. Consults with physician and nursing leadership according to established standards, policies, procedures, and… more
    Mount Sinai Health System (10/23/25)
    - Related Jobs

  • Practice Administrator OBGYN & GYN

    Crouse Hospital (East Syracuse, NY)
    …- a OBGYN office with six providers and GYN office with one Physician . Plans, develops, organizes, monitors and manages all protocols and activities to improve ... patient access and care. Ensures efficient utilization of all resources. Provides leadership, supervision and motivation of all staff. Works collaboratively with all… more
    Crouse Hospital (09/18/25)
    - Related Jobs

  • 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)
    - Related Jobs

  • 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)
    - Related Jobs

  • 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)
    - Related Jobs

  • 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 ... any other certification approved by management + Certification in a Nationally Recognized Utilization Review Criteria set is preferred EXPERIENCE + Minimum of… more
    Catholic Health (10/01/25)
    - Related Jobs

  • Health Insur & Auth Rep IV

    University of Rochester (Rochester, NY)
    …welcoming to all and is a place where all can thrive. **Job Location ( Full Address):** 601 Elmwood Ave, Rochester, New York, United States of America, 14642 ... **Opening:** Worker Subtype: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500183 Health Insurance Counseling Work Shift: UR - Day (United… more
    University of Rochester (10/18/25)
    - Related Jobs