• Registered Nurse ( RN )…

    Rochester Regional Health (Rochester, NY)
    …LICENSES / CERTIFICATIONS: BLS - Basic Life Support - American Heart Association (AHA), RN - Registered Nurse - New York State Education Department ... Job Title: Registered Nurse IDepartment: Utilization Management Location:...Week: 40 hours (Full-Time)Schedule: Monday - Friday, Days SUMMARY: Review all inpatient medical necessity denials for… more
    Rochester Regional Health (08/02/25)
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  • Director of Care Management - Mount Sinai Queens…

    Mount Sinai Health System (Long Island City, NY)
    …field. **Licensing and Certification Requirements (if applicable)** Licensed as a registered nurse , Issuing Agency: Department of Health/Office of Professions ... The Director will direct and manage departmental activities involved in utilization review , appeals management and discharge planning to facilitate the case… more
    Mount Sinai Health System (07/24/25)
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  • Clinical Appeals Nurse ( RN )

    Molina Healthcare (Yonkers, NY)
    …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/ medical reviews of previously ... **JOB DESCRIPTION** For this position we are seeking a ( RN ) Registered Nurse who must...for the state they reside This position will support Medical Review for Medicare and Marketplace request… more
    Molina Healthcare (08/02/25)
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  • Utilization and Appeals Manager

    Catholic Health Services (Melville, NY)
    …Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals according ... and/or escalates denial when appropriate. Submits all (initial and/or appeals ) reviews and/or letters within contractual or regulatory timeframes. Collaborates… more
    Catholic Health Services (07/24/25)
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  • Director of Case Management

    Stony Brook University (Stony Brook, NY)
    …**Required Qualifications:** * Master's degree. * Possession of license to practice as a registered nurse in New York State * Certification in ACM or CCM ... Work practice and collaboration with Social Work Services * Knowledge of Utilization Review and Denial/ Appeals * Knowledge of Data Analytics **Special Notes**… more
    Stony Brook University (06/24/25)
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  • RN Utilization Review - System Care…

    Guthrie (Binghamton, NY)
    …cases. Assists departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/ appeals . ... services regarding admissions, case management, discharge planning and utilization review . Responsibilites: Reviews admissions and service requests within assigned… more
    Guthrie (07/05/25)
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  • Inpatient Clinical & Coding Specialist - Senior

    Independent Health (Buffalo, NY)
    …+ Responsible for all reconsideration clinical appeals to include review of records, consultation with Medical Director, response to facilities ... (CCDS), American Health Information Management Association (CCS-H, CCS-P), Certification Denials and Appeals Management (C-DAM), or NYS licensed RN or LPN… more
    Independent Health (07/15/25)
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  • RN /Case Manager-MSH-Case…

    Mount Sinai Health System (New York, NY)
    **Job Description** ** RN /Case Manager MSH Case Management FT Days** The Case Manager (CM) will be responsible for all aspects of case management for an assigned ... experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred....or a minimum of 3-5 years? experience as a RN in an acute care setting. **Licensing and Certification… more
    Mount Sinai Health System (07/15/25)
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  • RN /Case Manager-Inpatient-Mount Sinai…

    Mount Sinai Health System (New York, NY)
    **Job Description** ** RN /Case Manager Inpatient Mount Sinai West FT Days 8a-4p EOW (Holiday Rotation)** The Case Manager (CM) will be responsible for all aspects of ... experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred....or a minimum of 3-5 years? experience as a RN in an acute care setting. + Current NYS… more
    Mount Sinai Health System (07/08/25)
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  • Utilization Management RN

    Guidehouse (New York, NY)
    **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** + Performs chart ... review of identified patients to identify quality, timeliness and...creating a diverse and supportive workplace. Benefits include: + Medical , Rx, Dental & Vision Insurance + Personal and… more
    Guidehouse (07/25/25)
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