• Medical Director - National…

    Humana (Albany, NY)
    **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
    Humana (10/25/25)
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  • Medical Director , Commercial Line…

    Excellus BlueCross BlueShield (Rochester, NY)
    …you see is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical ... reviews and may require peer-to-peer discussions with providers regarding UM case review determinations. + Provides clinical expertise on...and medical criteria. + Assists with training medical director colleagues and nursing staff ,… more
    Excellus BlueCross BlueShield (09/30/25)
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  • Medical Director (AZ)

    Molina Healthcare (NY)
    …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM ...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
    Molina Healthcare (10/17/25)
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  • Medical Director

    Molina Healthcare (Rochester, NY)
    …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... staff services. Maintains a working knowledge of applicable national , state, and local laws and regulatory requirements affecting...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
    Molina Healthcare (10/22/25)
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  • Clinical Reviewer, Nurse -9am -6pm PST

    Evolent (Albany, NY)
    …Tasks are performed within the RN/LVN/LPN scope of practice, under Medical Director direction, using independent nursing judgement and decision-making, ... that do not meet established clinical criteria to the Medical Director . + Appropriately identifies and refers.... + Appropriately identifies and refers quality issues to UM Leadership. + Appropriately identifies potential cases for Care… more
    Evolent (10/21/25)
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  • Utilization Management Reviewer, RN (Multiple…

    Excellus BlueCross BlueShield (Rochester, NY)
    …external standards set by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case ... refers potential quality of care and utilization issues to Medical Director . + Utilizes appropriate communication techniques...5 years. + Broad understanding of multiple areas (ie UM and CM). Incumbent is required to know multiple… more
    Excellus BlueCross BlueShield (10/07/25)
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  • Manager, Case Management

    Bassett Healthcare (Cooperstown, NY)
    …required by institutional guidelines + Make recommendations for improvement to Director Case Management + Ensures compliance with all regulatory agency requirements ... with departmental and institutional policies + Collaborates with the Director of Care Coordination on the development, review, and...(charge nurse, staff nurse) unit manager, and support team ( UM , MSW, SW, etc) to progress each patient's care… more
    Bassett Healthcare (10/10/25)
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  • Case Manager, Medicaid Long Term Support Program

    MVP Health Care (Tarrytown, NY)
    …care. + The Case Manager will also monitor and review cases with the Medical Director to ensure appropriate outcomes. + Service Authorization & Review: Conduct ... members. + Through collaborative efforts the Case Manager will identify the medical and psycho-social needs of designated members, act as a proactive partner,… more
    MVP Health Care (10/26/25)
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  • Case Manager, RN (Medicare)

    Excellus BlueCross BlueShield (Rochester, NY)
    …Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director , Pharmacist, Geriatrics, etc.) to ensure continuity ... for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards, as appropriate to… more
    Excellus BlueCross BlueShield (10/23/25)
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  • Electrical Engineering Manager

    ULTRA ELECTRONICS OCEAN SYSTEMS INC. (Victor, NY)
    …front-end modules, and digital signal processing electronics. Reporting to the Director of Electrical Engineering, you would provide leadership that fosters ... project execution challenges + Ensure all staff and programs comply with UM US engineering processes, policies, and standards + Provide technical oversight and… more
    ULTRA ELECTRONICS OCEAN SYSTEMS INC. (10/22/25)
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