• Remote UM Physician…

    Insight Global (New York, NY)
    … remote Physician Reviewers for a leading health insurance company. The Physician Reviewer will review requests for care before, during, and after ... they use the right templates to keep everything consistent. Physician Reviewers also talk directly with doctors when needed...handle other related tasks as needed. This is a remote position that requires strong attention to detail, clear… more
    Insight Global (12/28/25)
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  • Medical Director - Nat'l UM IP (4x10 hr)

    Humana (Albany, NY)
    …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 ... scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities,… more
    Humana (11/07/25)
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  • Clinical Reviewer , Nurse (Medical…

    Evolent (Albany, NY)
    …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are ... Medical Director's direction, using independent nursing judgement and decision-making, physician -developed medical policies, and clinical decision-making criteria sets. The… more
    Evolent (12/10/25)
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  • Utilization Management Reviewer , RN…

    Excellus BlueCross BlueShield (Rochester, NY)
    …regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member ... and treatment of members' medical health conditions, applying established clinical review criteria, guidelines and medical policies and contractual benefits as well… more
    Excellus BlueCross BlueShield (10/07/25)
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