• Nurse Case Manager, Per Diem

    Albany Medical Center (Albany, NY)
    …works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to achieve ... assigned service. Job Description * Assists the admission MD and or designated physician and the interdisciplinary teams in assuring coordination of care across the… more
    Albany Medical Center (09/25/25)
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  • Director Clinical and DRG Denials

    Kaleida Health (Buffalo, NY)
    …tactics to successfully execute, support, implement, and monitor the DRG and Utilization Management Clinical Denial teams Work Plan and, assists in the development ... facilitating strong working relationships between HIM, Clinical Documentation, UR, Physician Advisor operations, PFS, Contracting, and hospital departments and… more
    Kaleida Health (09/17/25)
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  • Health Insur & Auth Rep IV

    University of Rochester (Rochester, NY)
    …Identifies problems that include but are not limited to pre-certifications, Utilization Management, Medicaid Pending, third party payer issues, and denials/appeal ... and follow-up with assigned area, Financial Assistance, Social Work, Utilization Management, Medicaid Enrollment & Outreach, patients, families, third-party payers,… more
    University of Rochester (09/17/25)
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  • Medical Director - Claims Management

    Humana (Albany, NY)
    …scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post… more
    Humana (09/17/25)
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  • Senior Analyst, Medical Economics (Vbc) - Remote

    Molina Healthcare (NY)
    …and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Designs and develops reports ... medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.) + Proficiency with Microsoft… more
    Molina Healthcare (08/31/25)
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  • Manager, Medical Economics (Medicaid) - REMOTE

    Molina Healthcare (Buffalo, NY)
    …and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Analyzes data and dashboard ... medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.) + Strong Knowledge of… more
    Molina Healthcare (08/27/25)
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  • Director, Operating Room Throughput

    WMCHealth (Valhalla, NY)
    Director, Operating Room Throughput Company: WMC Advanced Physician Services PC City/State: Valhalla, NY Category: Clerical/Administrative Support Department: ... metrics such as on time case starts, OR capacity utilization , lead time from add-on case "booking time" to...NYS RN license, required. Other: About Us: WMC Advanced Physician Services PC Benefits: We offer a comprehensive compensation… more
    WMCHealth (10/02/25)
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  • SVP, Oncology

    Evolent (Albany, NY)
    …is a key clinical executive responsible for leading oncology-related utilization management, quality improvement, and clinical operations across Evolent's ... oncology care + Lead the development of strategies for care management, utilization mitigation, and value-based incentive programs **Desired Skill Set** + 15+ years… more
    Evolent (09/28/25)
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  • Case Manager - Per Diem

    Stony Brook University (Stony Brook, NY)
    …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR from ... patients who were readmitted within thirty days. Documents over utilization of resources and services. + All Medicare cases...on all other payers. + Active participation with the physician and payer to prevent denials. Reviews cases for… more
    Stony Brook University (09/26/25)
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  • Registered Nurse Case Manager II - Home Care

    Rochester Regional Health (Rochester, NY)
    …the patient (and their caregivers as applicable), in collaboration with the attending physician and other care team members + Manages and coordinates patient care, ... + Practices according to Agency and community standards + Participates in utilization review and/or continuous quality improvement activities as requested. + Attends… more
    Rochester Regional Health (09/23/25)
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