• Manager , Utilization Management…

    Evolent (Albany, NY)
    …for utilization management and use of project resources. **Qualifications - Required and Preferred ** + RN Licenses (Active and Unrestricted) - Required + ... with a global workforce and a working knowledge of clinical quality metrics such as HEDIS and NCQA - Preferred . + Skilled in inpatient and outpatient utilization… more
    Evolent (08/14/25)
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  • Utilization Management Mgr I (Hcms)

    Elevance Health (Latham, NY)
    …** Preferred skills, qualifications and experiences:** + Certified Case Manager Certification preferred + Utilization management experience highly recommended ... adherence to National Committee for Quality Assurance (NCQA) standards and HEDIS reporting. + Hires, trains, coaches, counsels, and evaluates performance of… more
    Elevance Health (08/13/25)
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  • Senior Specialist, Member & Community…

    Molina Healthcare (NY)
    …Certified Professional in Health Quality (CPHQ) + Nursing License ( RN may be preferred for specific roles) + Certified HEDIS Compliance Auditor (CHCA) To all ... activities and results to identify opportunities for improvement + Surfaces to the Manager and Director any gaps in processes that may require remediation + Other… more
    Molina Healthcare (07/31/25)
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