• Medical Director - Claims…

    Humana (Albany, NY)
    …a Lead Medical Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care ... **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement… more
    Humana (11/01/25)
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  • PCO Medical Director - UM - Full…

    CenterWell (Albany, NY)
    …us put health first** The Medical Director , Primary Care relies on medical background and reviews health claims . The Medical Director , Primary ... The Medical Director relies on medical background and reviews health claims . The...the Director of Physician Strategy at Utilization Management . The Medical Director conducts… more
    CenterWell (11/06/25)
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  • Medical Director - Medicaid N.…

    Humana (Albany, NY)
    …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in the… more
    Humana (10/25/25)
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  • Medical Director - Nat'l UM IP (4x10…

    Humana (Albany, NY)
    …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
    Humana (11/07/25)
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  • LPN-Utilization Mgmt Reviewer - Case…

    Guthrie (Cortland, NY)
    …as necessary with the hospital Business Office, physician offices, Care Coordination, Medical Director and other hospital departments as appropriate. + Serves ... Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination,...requirements and to assist in ensuring generation of clean claims in a timely manner + Securing authorization as… more
    Guthrie (10/28/25)
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  • Associate Director - Claims…

    WTW (New York, NY)
    …clients of their claim related obligations under the policy and establish client-specific claims management procedures + Provide claims advocacy on behalf ... **Description** **The Role** This role provides value-added claims leadership and management service for the management liability lines of coverage, acts as… more
    WTW (11/14/25)
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  • Claims Manager

    MTA (Brooklyn, NY)
    …TA/OA Department: Law Division/Unit: Torts Reports to: Assistant General Counsel / Director of Claims Work Location: 130 Livingston Street, Brooklyn Hours ... aid defense counsel; reviewing and drafting reports for senior management ; serving as liaison between the torts department and...damage claims brought against MTA agencies. Review claims and relevant factual and medical records… more
    MTA (08/21/25)
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  • Assistant Director - Workers Compensation…

    MTA (Brooklyn, NY)
    …and reduce overall costs. Some of the major responsibilities include supervising the TPA's claims management and medical provider networks as well as ... Assistant Director - Workers Compensation (Case Management )...Minimum 8 years progressively responsible experience in Workers' Compensation claims management and administration. At least 4… more
    MTA (11/07/25)
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  • Director , Strategic Planning & Operations…

    Otsuka America Pharmaceutical Inc. (Albany, NY)
    …the asset lifecycle. This role reports directly into the Executive Director , Medical Excellence and Operations. **Job Description** **Key Responsibilities ... The Director , Strategic Planning & Operations is a pivotal...multi-year strategic roadmaps tailored to each therapeutic area **Budget Management ** + Oversee budgets for global medical … more
    Otsuka America Pharmaceutical Inc. (11/14/25)
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  • Medical Director Aetna Duals Center…

    CVS Health (Albany, NY)
    …cover urgent cases can be done from your laptop. **Fundamental Components:** * Utilization management - The medical director will perform concurrent and ... services to its membership. Aetna is looking for a medical director to be part of a...licensure a plus. **Preferred Qualifications:** Previous Experience in Utilization Management / Claims Determination with another Health… more
    CVS Health (11/13/25)
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