• Utilization Manager Reviewer, RN…

    Excellus BlueCross BlueShield (Rochester, NY)
    …and departmental policy and procedure, identifies and refers potential quality of care and utilization issues to Medical Director. + Utilizes appropriate ... improving member and community health. + Manages more complex assignments; cross-trained to review various levels of care and/or services. + Participate in… more
    Excellus BlueCross BlueShield (08/23/25)
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  • Utilization Case Manager - Inpatient…

    Helio Health Inc. (Syracuse, NY)
    …+ Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care , or managed care setting. ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
    Helio Health Inc. (09/30/25)
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  • Registered Nurse (RN) - Utilization…

    Monroe County, NY (Rochester, NY)
    Full Jobs List Full Exams List Registered Nurse (RN) - Utilization Review Unit, Per Diem Location: Rochester, NY Title: Registered Nurse (RN) - Utilization ... Hospital Description of Duties This position is in the Utilization Review Unit and functions as an...a professional nursing position involving responsibility for providing nursing care that may include bedside and/or clinical care… more
    Monroe County, NY (08/02/25)
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  • RN, Manager , Utilization Management…

    Humana (Albany, NY)
    …Registered Nurse (RN) license in the state of Michigan. + Previous experience in utilization management and/or utilization review . + Minimum of two (2) ... caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization...procedures to provide the best and most appropriate treatment, care , or services for members. + Hire, train, coach,… more
    Humana (09/28/25)
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  • Utilization and Appeals Manager

    Catholic Health Services (Melville, NY)
    …why Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... to MCC in response to physician order, or review of updated clinical information + Acts as a...current with industry standards and business objectives related to Utilization and Care Management as appropriate. +… more
    Catholic Health Services (07/24/25)
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  • Utilization Manager -OASAS Program

    Samaritan Daytop Village (Rhinebeck, NY)
    …goal of sustaining high quality care /service delivery to persons served, the Utilization Manager works to assist CASAC Counselors and supervisory staff as ... needed with assuring compliance with external and internal utilization review /quality and appropriateness requirements. What qualifications do you need: +… more
    Samaritan Daytop Village (09/30/25)
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  • CHS Utilization and Appeals Coordinator

    Catholic Health Services (Melville, NY)
    …services and coordinates utilization /appeals management review . + Assist Utilization and Appeals Manager in setting up communications with payors and/ ... payors. + Serves as a liaison between patient account services, physicians, care coordinators, Utilization and Appeals Managers, physician advisors and facility… more
    Catholic Health Services (09/09/25)
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  • Pharmacist, Utilization Management (UM)…

    Molina Healthcare (Yonkers, NY)
    …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing and measuring performance… more
    Molina Healthcare (09/25/25)
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  • Insurance Specialist-Mount Sinai West-…

    Mount Sinai Health System (New York, NY)
    **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front end operations of the Case Management Department by ... Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. Clinical/Technical/Service**… more
    Mount Sinai Health System (07/23/25)
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  • Utilization Management Representative II

    Elevance Health (Latham, NY)
    ** Utilization Management Representative II** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... unless an accommodation is granted as required by law._ The ** Utilization Management Representative II** is responsible for managing incoming calls, including… more
    Elevance Health (09/25/25)
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