• Pre-Authorization Registered Nurse

    Humana (Albany, NY)
    …guidelines/procedures. **Use your skills to make an impact** **Required Qualifications** + Active Licensed Registered Nurse ( RN ) in the state of Virginia or ... community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care...experience a plus + Previous Occupational and Physical Therapy utilization review + Previous experience in … more
    Humana (07/16/25)
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  • Registered Nurse 2 (Medical Care)…

    New York State Civil Service (Menands, NY)
    NY HELP Yes Agency Workers' Compensation Board Title Registered Nurse 2 (Medical Care) (NY HELPS), WCB Items #1885, 3357, and 4271 Occupational Category Health ... Zip Code 12204 Duties Description Under the direction of Registered Nurse Supervisor, SG 23, within the...medical/surgical, public health, community health, visiting nursing, occupational health, utilization review , or review of… more
    New York State Civil Service (07/11/25)
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  • Utilization Management Reviewer, RN…

    Excellus BlueCross BlueShield (Rochester, NY)
    …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member… more
    Excellus BlueCross BlueShield (06/25/25)
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  • Utilization Review Clinician…

    Centene Corporation (New York, NY)
    …Health Professional (LMHP) required or + Licensed Master Social Worker (LMSW) required or + RN - Registered Nurse - State Licensure and/or Compact State ... abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
    Centene Corporation (06/27/25)
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  • Care Manager RN - ( Remote )

    Highmark Health (Albany, NY)
    …Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management,… more
    Highmark Health (07/12/25)
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  • RN Clinical Manager

    CenterWell (Westbury, NY)
    …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
    CenterWell (06/21/25)
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  • RN Care Coordinator PCMH (Patient Centered…

    Guthrie (Corning, NY)
    …data analysis and process outcome evaluation. Education, License & Cert: Licensed Registered Nurse . Bachelor's Degree in Nursing or related field required. ... applicant must have a current license as a Professional Registered Nurse in their state of practice...in nursing practice. Preferred experience with PCMH process, care management/ utilization review , and payer knowledge. Fast paced… more
    Guthrie (04/25/25)
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  • Case Manager, RN or Licensed Behavioral…

    Excellus BlueCross BlueShield (Rochester, NY)
    …varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, ... of consistent and quality health care services. Examples may include: Utilization Management, Quality, Behavioral Health, Pharmacy, Registered Dietitian and… more
    Excellus BlueCross BlueShield (06/27/25)
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  • Disease Management Nurse - Remote

    Sharecare (Albany, NY)
    …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more
    Sharecare (07/12/25)
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  • Clinical Review Nurse - Prior…

    Centene Corporation (New York, NY)
    …**License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + RN - Registered Nurse - State Licensure preferred Pay Range: ... criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care +… more
    Centene Corporation (06/18/25)
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