• Case Management Supervisor - Full Time…

    Mohawk Valley Health System (Utica, NY)
    …Management Supervisor is responsible for the oversight of the case management staff's authorization /coordination/ utilization and provision of member ... as needed to assist with the day to day operation of the Case Management department. + Assists with identifying over- utilization of services and reports trends… more
    Mohawk Valley Health System (11/21/25)
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  • Financial Clearance Center Representative

    Catholic Health Services (Melville, NY)
    …initiated within 24 hours of admission / arrival. + Coordinate with onsite Case Management and Utilization Management to guarantee payer requirements are met ... system to secure authorizations for scheduled procedures requiring an authorization , prior to the date of service....Utilize work queues/work drivers and reports as assigned by management , to complete daily tasks. + Confirm that a… more
    Catholic Health Services (12/09/25)
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  • Clinical UM Pharmacist

    Healthfirst (NY)
    **Duties & Responsibilities:** + **Monitor and review prior authorization requests for medications** + **Calculate appropriate billable units based on dosing, ... drug knowledge and disease state understanding for application to prior authorization reviews** + **Ensure prior...NYSDOH** + **Work across departments as needed to complete Utilization Management reviews** + **Review monthly reports… more
    Healthfirst (01/13/26)
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  • Scheduler

    Northwell Health (Lake Success, NY)
    …appointment reminders and prepare patient packets with necessary pre-procedure instructions. Authorization & Insurance Management : + Verify patient insurance ... other relevant departments. Manage and optimize provider schedules, ensuring efficient utilization of clinic and procedure block times. Reschedule and cancel… more
    Northwell Health (01/17/26)
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  • RN Case Manager

    Stony Brook University (Stony Brook, NY)
    …with the transferring hospital, Patient Access and physicians and payers for authorization prior to transfer from other hospitals. + Consistent documentation ... the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity...and communication with the team. Charting includes data for authorization and data management . + Reviews cases… more
    Stony Brook University (10/23/25)
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  • Health Insur & Auth Rep IV

    University of Rochester (Rochester, NY)
    …discharge. Identifies problems that include but are not limited to pre-certifications, Utilization Management , Medicaid Pending, third party payer issues, and ... communication and follow-up with assigned area, Financial Assistance, Social Work, Utilization Management , Medicaid Enrollment & Outreach, patients, families,… more
    University of Rochester (12/13/25)
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  • UM Care Coordinator

    Centers Plan for Healthy Living (Staten Island, NY)
    …with the guidance and plans they need for healthy living. JOB SUMMARY: The Utilization Management Care Coordinator works within a multidisciplinary care team to ... requests for eligible members. PRIMARY RESPONSIBILITIES: + Assists in the prior authorization of services and ongoing authorization requests + Assists in… more
    Centers Plan for Healthy Living (01/12/26)
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  • RN UM Care Review Clinician Remote

    Molina Healthcare (Rochester, NY)
    …and cost-effective member care. We are seeking candidates with a RN licensure, Utilization Management knowledge and Medicare Appeals is strongly preferred. Work ... stay for requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its members. *… more
    Molina Healthcare (01/14/26)
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  • Sr Manager Clinical UM Operations

    Healthfirst (NY)
    …strategic oversight and operational management for all utilization management functions, including prior authorization , concurrent review, and ... efforts for audits, performance improvement plans, and corrective actions related to utilization management + Foster a culture of accountability, professional… more
    Healthfirst (11/27/25)
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  • Care Review Clinician (RN)

    Molina Healthcare (Buffalo, NY)
    …and or compact licensure The Care Review Clinician Inpatient Review BH will provide prior authorization for outpatient and inpatient services for the KY Medicaid ... stay for requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its members. *… more
    Molina Healthcare (01/15/26)
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