• 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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  • RN , Utilization Management

    University of Rochester (Rochester, NY)
    …majority of work is remote with some on-site requirements as needed. Qualifications: RN with Utilization Review experience preferred; 3-5 years of recent ... of the individual, and internal equity considerations._ **Responsibilities:** The Utilization Management (UM) RN position spans the...Social Work, Patients, and various insurance companies. The UM RN is responsible for the review of… more
    University of Rochester (07/19/25)
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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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  • Clinical Appeals Nurse ( RN )

    Molina Healthcare (NY)
    **JOB DESCRIPTION** _For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state of UTAH or have a compact license._ _This ... Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support,… more
    Molina Healthcare (07/20/25)
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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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