• Utilization Management RN

    Guidehouse (New York, NY)
    …based on physician certification + Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis + Performs ... **Job Family** **:** Clinical Appeals Nurse ** Travel Required** **:** None **Clearance Required** **:** None...None **What You Will Do** **:** + Performs chart review of identified patients to identify quality, timeliness and… more
    Guidehouse (07/25/25)
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  • Utilization Management Nurse

    CenterWell (Albany, NY)
    …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
    CenterWell (08/02/25)
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  • Utilization Management Nurse

    CenterWell (Albany, NY)
    …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
    CenterWell (08/08/25)
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  • Care Review Clinician, PA (RN)

    Molina Healthcare (Buffalo, NY)
    …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
    Molina Healthcare (08/08/25)
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  • Business Review Specialist

    Agiliti Health (NY)
    **POSITION SUMMARY** Create and deliver high-impact, customer-facing business- review presentations that clearly communicate Agiliti's value, service performance, and ... contract utilization trends. This role blends visual storytelling expertise with...AND RESPONSIBILITIES** + Design and produce facility- and division-level business- review decks that highlight service performance, spend trends, and… more
    Agiliti Health (07/26/25)
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  • Care Review Clinician, PA (RN) Transplants

    Molina Healthcare (Yonkers, NY)
    …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
    Molina Healthcare (07/17/25)
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  • Medical Director, Commercial Line…

    Excellus BlueCross BlueShield (Rochester, NY)
    …II (in addition to Level I Qualifications) + Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge of ... recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range… more
    Excellus BlueCross BlueShield (07/01/25)
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  • Travel , Card, and Expense Coordinator

    Global Foundries (Malta, NY)
    …their markets. For more information, visit www.gf.com . Summary of Role: The travel , Card and expense coordinator will oversee the administrative support across all ... travel , card, and expense activities. This individual will be...card status, renewals, and credit limits + Run and review delinquency reports monthly and follow up on late… more
    Global Foundries (08/02/25)
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  • Care Review Clinician, ABA (Licensed…

    Molina Healthcare (Rochester, NY)
    …stay for requested treatments and/or procedures. * Works collaboratively with the Utilization and Case Management departments to provide ABA/BHT services to Molina ... by reviewing Behavioral Health Therapy (BHT) assessments and treatment plans for medical necessity and BHT best practice guidelines. This includes but is not… more
    Molina Healthcare (08/08/25)
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  • Care Review Clinician, Inpatient…

    Molina Healthcare (Rochester, NY)
    …needed. + Processes requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner. + ... promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or hospitals as requested, may be required. This can… more
    Molina Healthcare (08/03/25)
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