• Licensed Master Social Worker - Emergency…

    Trinity Health (Syracuse, NY)
    …stakeholder in the emergency room care transition team which includes nurse case managers, utilization review nurses, providers, and etc. whom all work to ensure ... emergency department environment. Ability to communicate effectively with patient, family, medical team and other professions within hospital and in the community.… more
    Trinity Health (07/11/25)
    - Related Jobs
  • Health Insurance & Authorization Specialist I

    Highland Hospital (Rochester, NY)
    …information is on file and accurately documented. These activities include review diagnosis and history for correct insurance coverage, insurance eligibility and ... estimated cost and collects deposits for non-covered services, ensures appropriate medical justification is documented for out-of-network payers, refers our self-pay… more
    Highland Hospital (07/05/25)
    - Related Jobs
  • Assistant Materials Coordinator - Central Sterile…

    Catholic Health Services (Smithtown, NY)
    …a 240-bed nursing and rehabilitation care center; and a 60,000 square foot medical office building. Our nurses, physicians, and support staff are devoted to ... maintain the records of Central Sterile Performance Improvement and IUSS utilization reports. Coordinates and maintains instrumentation repairs. He/she will assist… more
    Catholic Health Services (06/27/25)
    - Related Jobs
  • Administrator - Assisted Living Memory Care…

    Rochester Presbyterian Home (Rochester, NY)
    …and approved by RPH. + Reports findings to other departments such as utilization review , infection control, and risk management. + Responsible for ensuring ... needs concerning a resident's condition, relying on nursing and medical staff for assessment of physical condition. Must be...all resident incidents are accurately documented in the medical record, logged for tracking purposes, and analyzed for… more
    Rochester Presbyterian Home (06/26/25)
    - Related Jobs
  • DPM- Surgery

    Touro University (New York, NY)
    …scientific texts/journals; funded research or research approved by the College Peer Review Committee; other scholarly works; on a yearly basis. + Attendance at ... for all emergency assignments. + Become proficient in the utilization of educational and clinical technology products acquired by...which includes: + Full range of Health Plans + Medical Plans (choice of EPO, PPO, High Deductible HSA)… more
    Touro University (06/17/25)
    - Related Jobs
  • Care Coordinator-Care Coordination

    Comunilife (New York, NY)
    …Program Director to assure quality program service delivery and participates in Utilization Review /Quality Improvement process. + Participate in case finding, ... follow-up to engage the client in care, promotes compliance with medical appointments, and encourages client self-sufficiency and empowerment. This position is… more
    Comunilife (06/13/25)
    - Related Jobs
  • Academic Student Support Specialist

    CUNY (New York, NY)
    …of Medicine (CUNY SoM) located in the heart of Harlem, New York, is the only medical school in the City University of New York system and the only public medical ... True to its legacy of access, opportunity, and community transformation, the medical school's mission remains to recruit highly talented students as diverse as… more
    CUNY (06/03/25)
    - Related Jobs
  • Hospital Case Manager - Registered Nurse (RN)

    MVP Health Care (Rochester, NY)
    …to confidentiality. + Ability to make independent decisions regarding resource utilization , and quality of care. + Must demonstrate understanding of clinical ... hospital discharge staff, the Care Manager will identify the medical and psychosocial needs of members, function as a...care. + The Care Manager will also monitor and review cases with the appropriate provider and on-site clinical… more
    MVP Health Care (05/20/25)
    - Related Jobs
  • Manager, HCS Operations Support

    Molina Healthcare (NY)
    …teams that support one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity, ... health plan supervisory experience. Managed Care operations experience. Prior Medical Assistant experience. **Preferred License, Certification, Association** n/a To… more
    Molina Healthcare (08/16/25)
    - Related Jobs
  • Medicaid Provider Materials Lead

    Humana (Albany, NY)
    …meet required timelines. + Submits required documents to state agencies for review and approval. + Regularly meet with Humana Healthy Horizons Medicaid markets ... operations, such as provider relations, claims submission and payment, utilization management processes, behavioral health processes, and dispute resolution. **Work… more
    Humana (08/16/25)
    - Related Jobs