• PCO Medical Director- UM - Full Time

    CenterWell (Albany, NY)
    …Director of Physician Strategy at Utilization Management. The Medical Director conducts Utilization review of the care received by members in an assigned ... 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
    CenterWell (11/06/25)
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  • Medical Services Coordination Specialist I/II/III

    Excellus BlueCross BlueShield (Rochester, NY)
    …Specialist provides administrative support for any of the programs of Utilization Management, Behavioral Health, Quality Management, or Member Care Management. This ... regulatory mandates related to the Health Plan Essential Accountabilities: Level I + Review / prep clinical case for clinical staff. + Navigates and utilizes… more
    Excellus BlueCross BlueShield (10/21/25)
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  • Medical Director-Payment Integrity

    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 (12/11/25)
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  • Plan Performance Medical Director- New York…

    Elevance Health (New Hyde Park, NY)
    …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... clinical reviews with attending physicians or other providers to discuss review determinations. + May conduct peer-to-peer clinical appeal case reviews with… more
    Elevance Health (12/10/25)
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  • Social Worker Manager

    University of Rochester (Rochester, NY)
    …+ Oversees quality improvement and quality assurance activities including peer review and client satisfaction reports. Attends and presents at quarterly UHS ... QI meetings. Leads the creationg and review of UHS and UCC policies and procedures related...including type and scope of service provision, tracking of utilization of services, and research on outcome of services.… more
    University of Rochester (12/03/25)
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  • Medical Director - Pharmacy Appeals

    Humana (Albany, NY)
    …Delivery Systems, health insurance, or clinical group practice management + Utilization management experience in a medical management review organization ... us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments… more
    Humana (12/03/25)
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  • Case Manager D-RN

    WMCHealth (Margaretville, NY)
    …admission medical records. + UR-Reports concerns re: admissions and continued stay to Utilization Review Chair person and Medical Director. + UR- Prepares ... selected patients across the health care continuum. Promotes effective utilization of resources and the highest quality of care...monthly statistical report for monthly review at the UR Committee meeting. + UR-Provides clinical… more
    WMCHealth (12/02/25)
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  • Data Center Facilities Engineering Director

    Oracle (Albany, NY)
    …are achieved, maintenances are performed with minimal risk, manage capacity utilization , address local maintenance requirements, and support technical projects. The ... responsibilities include change management, incident & event support, space utilization , efficiency upgrades, and general engineering support. Directors are expected… more
    Oracle (11/25/25)
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  • RN, Quality Assurance

    University of Rochester (Rochester, NY)
    …application of strict inclusion/exclusion criteria and protocols. Performs meticulous chart review and enters clinical data into the quality databases to identify ... for improved outcomes, reduced cost, improved LOS, and best practice utilization of resources. Performs complete and accurate collection of preoperative, operative,… more
    University of Rochester (11/06/25)
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  • OR Program Director/Physician Associate - Women's…

    Mount Sinai Health System (New York, NY)
    …with vendors and surgical teams on equipment, monitoring OR block time utilization , and participating in process improvement projects. The PA Program Director must ... infection status. **PLANNING OF DAILY SURGICAL CASE WORKFLOW:** + Daily review of next-day cases to optimize instrumentation, material needs, and equipment.… more
    Mount Sinai Health System (09/17/25)
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