• Care Review Clinician, Prior

    Molina Healthcare (Buffalo, NY)
    …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. +...of the following: Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN)… more
    Molina Healthcare (08/31/25)
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  • Care Review Clinician, Prior Auth (RN) Pega…

    Molina Healthcare (NY)
    …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... its members. + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional… more
    Molina Healthcare (07/12/25)
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  • Advanced Registered Nurse Practitioner…

    STG International (Plattsburgh, NY)
    STGi is currently seeking a Nurse Practitioner (NP) or Physician Assistant (PA) to provide services at our Community Based Outpatient Clinic. The general duty of the ... Nurse Practitioner (NP) or Physician Assistant (PA) is to...Scope of Practice/Collaborative Agreement with a state licensed physician prior to delivery of health care). + Current and… more
    STG International (08/08/25)
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  • Utilization Management Registered Nurse

    Humana (Albany, NY)
    …a team **Preferred Qualifications** + Bachelor's degree + Previous experience in prior authorization , claims, and/or utilization management in healthcare, health ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and… more
    Humana (09/04/25)
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  • Nursing - Registered Nurse Manager

    Project Renewal, Inc. (New York, NY)
    Title: Nurse Care Manager for Drug User Health Services Location: Ft Washington Shelter (Manhattan) Salary: $110,000 - $120,000 Program Overview: Project Renewal ... of HIV and Hepatitis C infection. Position Overview: Project Renewal is seeking a Nurse Care Manager (NCM) for Drug User Health Services that would coordinate care… more
    Project Renewal, Inc. (08/26/25)
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  • Registered Nurse Scheduler - Vascular…

    Trinity Health (Syracuse, NY)
    …104 Union Ave ste 1005 Syracuse, NY 13203 MOC building 10th floor **Registered Nurse Scheduler** The RN Scheduler contributes to the overall success of the patient's ... to ensure cases are scheduled, coded accurately, secure insurance authorization if indicated and confirm that a safe surgical...a safe surgical plan is in place 5-7 days prior to DOS. In addition, the RN Scheduler will… more
    Trinity Health (06/24/25)
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  • Residential Assistant Nurse Manager…

    Hillside Family of Agencies (Rochester, NY)
    …pre-placements to obtain medical/psychiatric history, establish health care needs, and complete prior authorization for medications or medical necessity based on ... $5,000 FULL-TIME REGISTERED NURSE SIGN-ON BONUS! Job Summary The Assistant Nurse Manager supports the delivery of quality health services to youth at a site or… more
    Hillside Family of Agencies (08/15/25)
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  • Nurse Coordinator - Therapeutic Foster Care…

    Hillside Family of Agencies (NY)
    …pre-placements to obtain medical/psychiatric history, establish health care needs, and complete prior authorization for medications or medical necessity based on ... $5,000 FULL TIME REGISTERED NURSE SIGN ON BONUS! Job Summary The Nurse Coordinator provides health care oversight and medical case management for an identified… more
    Hillside Family of Agencies (06/24/25)
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  • Nurse - Cardiology Office - Triage…

    Trinity Health (Albany, NY)
    …delivered when patients call with cardiac symptoms. Patient education via phone or nurse visits. Prescription refills, prior authorization for medicine. ... **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Nurse - RNII -Cardiology Office - Phone Triage - Albany, NY - Full Time** If you are looking… more
    Trinity Health (09/02/25)
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  • Utilization Review Nurse I

    Centene Corporation (New York, NY)
    …Provider. + Provides first level RN review for all outpatient and ancillary prior authorization requests for medical appropriateness and medical necessity using ... a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all outpatient and… more
    Centene Corporation (08/02/25)
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