• Utilization Review Nurse

    Albany Medical Center (Albany, NY)
    …and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... environment.* Basic knowledge of computer systems with skills applicable to utilization review process.* Excellent written and verbal communication skills.*… more
    Albany Medical Center (04/25/25)
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  • RN Manager Healthcare Services…

    Molina Healthcare (Yonkers, NY)
    …state they reside. We are looking for a RN Manager to manage a utilization management team supporting 14 Marketplace plans. Home office with internet ... performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.),… more
    Molina Healthcare (05/10/25)
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  • Coordinator, Utilization Management

    Evolent (Albany, NY)
    …mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, Utilization … more
    Evolent (05/03/25)
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  • CHS Utilization and Appeals Manager

    Catholic Health Services (Melville, NY)
    …has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. ... our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes - to every patient, every time. We are… more
    Catholic Health Services (03/19/25)
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  • RN Clinical Manager Home Health

    CenterWell (Liverpool, NY)
    …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... clinical personnel. This role is a focused on both home health clinical quality assurance and home ...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more
    CenterWell (04/01/25)
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  • Supervisor, Health Home Programs

    CAMBA (Brooklyn, NY)
    …the challenges faced by nearly 1.7 million New Yorkers today. CAMBA's Health Home program focused on improving the health outcomes for individuals with severe mental ... reduce the length of hospitalizations. CAMBA's participation in health home places it at the forefront of a broad...goals (dates achieved) and document via progress notes. + Review all documentation related to clients' progress for accuracy,… more
    CAMBA (04/10/25)
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  • RN Care Coordinator PCMH (Patient Centered Medical…

    Guthrie (Johnson City, NY)
    …and autonomy in nursing practice. Preferred experience with PCMH process, care management/ utilization review , and payer knowledge. Fast paced ambulatory care ... as a practice support in the Patient Centered Medical Home development and process. The position is an integral...for coordinating the medical management of patients, using an outcomes‐ based approach. In collaboration with other members of the… more
    Guthrie (05/06/25)
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  • Sr. Analyst, Process Excellence - Work…

    CVS Health (Albany, NY)
    …for bi-weekly VP/SVP issue escalation calls and monthly Quality & Audit Review Board meetings. + Support the Program Manager in maintaining reporting cadences ... analysis, or business intelligence. + Experience working in payer healthcare, Utilization Management (UM), Care Management (CM), or clinical operations preferred. +… more
    CVS Health (05/03/25)
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  • BCBA-D ABA UM Reviewer

    Humana (Albany, NY)
    …explain the rationale behind utilization management decisions, + Work includes computer- based review of moderately complex to complex clinical scenarios, ... least 2 years of experience post-training providing clinical services . Experience in utilization management review and case management in a health plan setting… more
    Humana (05/07/25)
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  • Assistant Agency Chief Contracting Officer…

    City of New York (New York, NY)
    …overall policy and implementation strategies related to M/WBE reporting, outreach and utilization . - Effectively work with ACCO and Agency Staff, and with external ... the full array of procurement activities related to M/WBE utilization . Ensure that work is conducted timely and in...and colleagues from other City Agencies. MWBE Reporting: Extract, review , and assess complex and diverse data sets pertaining… more
    City of New York (02/12/25)
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