• Utilization Manager Reviewer, RN…

    Excellus BlueCross BlueShield (Rochester, NY)
    …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member… more
    Excellus BlueCross BlueShield (08/23/25)
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  • Utilization Case Manager - Inpatient…

    Helio Health Inc. (Syracuse, NY)
    …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care ... 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...and works under the general supervision of a Nurse Manager , or other higher-level staff member. General supervision may… 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) ... of our caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization Management Leader) utilizes clinical… 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 ... additional clinical documentation. + Acts as liaison between the Utilization and Appeals Management Department and the physician of...care to MCC in response to physician order, or review of updated clinical information + Acts as a… more
    Catholic Health Services (07/24/25)
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  • Utilization Manager -OASAS Program

    Samaritan Daytop Village (Rhinebeck, NY)
    …and 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/ ... as well as all financial metrics associated with front-end review process. + Collects data, prepares analysis, and oversees...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 (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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  • 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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  • 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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