- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Utilization Management (UM) Director , Clinical Strategy and Practice for Medicaid ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director , Clinical Strategy and Practice… more
- Mount Sinai Health System (New York, NY)
- …and efficient care to patients, the delivery of comprehensive front-line Case Management services, including utilization management , care facilitation and ... **Job Description** The Assistant Director of Case Management supports the... management is preferred Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …is required. + Managed care experience is strongly preferred, especially experience in utilization management . In lieu of managed care experience, proven record ... and documentation of findings for submission to the medical director for final determination, as required by law. +...years' experience in a managed care setting, specifically in utilization management . + Experience and skillset in… more
- Zurich NA (Albany, NY)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
- CVS Health (Albany, NY)
- …do it all with heart, each and every day. **Position Summary** This ** Utilization Manager** position is with Aetna's Long-Term Services and Supports (LTSS) team and ... to service requests. Works closely with leadership and Medical Director on member requests. This role is responsible to...unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of clinical experience… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …of the Medical Services area including, but not limited to, Medical and Pharmacy Utilization Management , quality management , member care management , and ... State and Federal Mandates and maintains current and working knowledge of Utilization Management Standards. + Clinical skills are excellent and evidence-based… more
- City of New York (New York, NY)
- …TASK FORCE: Management & Operations JOB TITLE: One (1) Assistant Director of Management and Operations CONTROL CODE: MOT-24-01 Summary: The Mayor's ... a more streamlined and responsive city government. Job Description: The Assistant Director of Management and Operations will provide leadership, strategic… more
- Humana (Albany, NY)
- …to the Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- Evolent (Albany, NY)
- …classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as ... for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of...reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with… more
- Humana (Albany, NY)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more