• Manager , Grievance and Appeals, RN

    VNS Health (Manhattan, NY)
    …years' experience in a Grievance and Appeals or related area such as medical or utilization management in a Managed Care setting required + Experience in a ... of healthcare? VNS Health Plans is seeking a dedicated Manager , Grievance and Appeals ( RN )to lead the...+ License and current registration to practice as a registered professional nurse in New York State… more
    VNS Health (03/05/25)
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  • MDS Coordinator RN

    Glengariff Rehabilitation and Healthcare Center (Glen Cove, NY)
    …and as directed by their supervisor and Administrator MDS Coordinator Qualifications: + Registered Nurse with current, active license in state of practice. + ... MDS Coordinator RN The Glengariff Healthcare Center is looking for...regulations and company policy and procedures.Acts as in-house case manager by considering all aspects of the residents care… more
    Glengariff Rehabilitation and Healthcare Center (04/22/25)
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  • RN Case Manager - Full Time - Days

    Mohawk Valley Health System (Utica, NY)
    RN Case Manager - Full Time - Days Department: CASE MANAGEMENT Job Summary Reports to and is under direct supervision of Case Management Department. ... compliance. Education/Experience Requirements Required: + Minimum of two (2) years utilization review/case management experience or social work experience.… more
    Mohawk Valley Health System (04/16/25)
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  • Education Manager , RN (Health…

    VNS Health (Manhattan, NY)
    …license and registration to practice as a Registered Professional Nurse CM certification (Certified Care Management ) preferred Education: Bachelor's Degree ... Join us at VNS Health Plans as an Education Manager ( RN ) and make a meaningful impact...cutting edge of healthcare excellence. Bring your experience in Utilization Management to develop new and modify… more
    VNS Health (03/05/25)
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  • RN -Hospital Supervisor - Part…

    Mohawk Valley Health System (Utica, NY)
    …+ Responds to concerns from staff, patients or families in the absence of the Nurse Manager , and as assigned. + Completes administrative reports to Nurse ... requirements. + Data collection and evaluation as designated by Nurse Manager + Offers staff coaching as...Licensure/Certification Requirements REQUIRED: + Valid, unrestricted License as a Registered Nurse in the State of New… more
    Mohawk Valley Health System (04/23/25)
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  • RN Case Management - Acute Care, St.…

    Trinity Health (Albany, NY)
    …experience in acute setting **Preferred requirements:** + 1+ year of experience in case management or utilization management + Case Management ... **Employment Type:** Full time **Shift:** Day Shift **Description:** ** RN Case Manager ** **Full-Time Days** **St....Engage the patient and care team in the joint management of key patient outcomes such as management… more
    Trinity Health (05/02/25)
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  • LTSS Service Coordinator - RN Telehealth

    Elevance Health (NY)
    …or CT) and within 50 miles of a PulsePoint. The **LTSS Service Coordinator - RN Telehealth** is responsible for overall management of member's case within the ... **LTSS Service Coordinator - RN Telehealth** _Location:_ While this position is fully remote, candidate must reside in the tri-state area (NY, NJ,… more
    Elevance Health (04/09/25)
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  • RN -Ambulatory - Urogynecology Nurse

    Albany Medical Center (Albany, NY)
    …Salary range: $68,640 - $99,023 Under the Supervision of the Nursing Supervisor and/or Nurse Manager , the RN provides nursing support to primary and ... utilization of resources to meet patient outcomes (case management ). + Analyzes patient care needs and utilizes a...staff + Works with division physicians, administrative staff and Nurse Manager to assure compliance with regulatory… more
    Albany Medical Center (03/31/25)
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  • Clinical Appeals Nurse ( RN )

    Molina Healthcare (Albany, NY)
    …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
    Molina Healthcare (04/20/25)
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  • LTSS Service Coordinator - RN

    Elevance Health (Buffalo, NY)
    …to client needs, and direct, hands-on engagement._ **The LTSS Svc Coordinator RN -Clinician** is responsible for overall management of member's case within ... the scope of licensure. The RN has overall responsibility to develop the care plan for services for the member and ensures the member's access to those services.… more
    Elevance Health (04/26/25)
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