• RN, Manager , Utilization…

    Humana (Albany, NY)
    **Become a part of our caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization Management ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works within specific… more
    Humana (09/28/25)
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  • Utilization Manager Reviewer, RN…

    Excellus BlueCross BlueShield (Rochester, NY)
    …+ Demonstrates general understanding of coding standards + Maintains current and working knowledge of Utilization Management Standards. + Experience in ... depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of… more
    Excellus BlueCross BlueShield (08/23/25)
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  • Project Manager , Utilization - MWBE

    New York State Civil Service (New York, NY)
    NY HELP No Agency Empire State Development, NYS Title Project Manager , Utilization - MWBE Occupational Category Other Professional Careers Salary Grade NS ... the direct supervision of the Director of Contract Participation, the Project Manager , Utilization , will lead the planning, execution, and monitoring of… more
    New York State Civil Service (09/04/25)
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  • Utilization Case Manager - Inpatient…

    Helio Health Inc. (Syracuse, NY)
    …to track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting ourSyracuse ... Educate program staff on current principles and standards of practice surrounding utilization and denials management . + Use effective relationship management… more
    Helio Health Inc. (09/30/25)
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  • Utilization and Appeals Manager

    Catholic Health Services (Melville, NY)
    …current with industry standards and business objectives related to Utilization and Care Management as appropriate. + Sound knowledge and skill in the use of ... was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts...additional clinical documentation. + Acts as liaison between the Utilization and Appeals Management Department and the… more
    Catholic Health Services (07/24/25)
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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/ ... and Appeals Coordinator will perform activities to help facilitate utilization management and appeals functions to include...and facility departments. + Develops/validates daily work lists for Utilization and Appeals Manager . + Assist with… more
    Catholic Health Services (09/09/25)
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  • Pharmacist, Utilization Management…

    Molina Healthcare (Yonkers, NY)
    … (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management ), clinical pharmacy ... **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members have access to all medically necessary prescription… more
    Molina Healthcare (09/25/25)
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  • Clinical Learning Facilitator - Utilization…

    Molina Healthcare (Buffalo, NY)
    …unrestricted State RN or Clinical Social Worker/Counseling License. + Certified Case Manager (CCM), Utilization Management Certification (CPHM), Certified ... state board licensing mandate. + At least 2 years in case, disease or utilization management ; managed care; or medical/behavioral health settings. + One year of… more
    Molina Healthcare (09/17/25)
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  • Insurance Specialist-Mount Sinai West-…

    Mount Sinai Health System (New York, NY)
    …Excel and Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...EOW** To maintain front end operations of the Case Management Department by monitoring all incoming correspondence and ensuring… more
    Mount Sinai Health System (07/23/25)
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  • RN Acute Case Manager - System Care…

    Guthrie (Binghamton, NY)
    …approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of ... Bonus For Qualified RNs! Position Summary: The Acute Case Manager utilizes industry accepted processes for achieving optimal patient,...experience in an acute care setting with strong care management , utilization review, and payer knowledge… more
    Guthrie (08/27/25)
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