• Utilization and Appeals Manager

    Catholic Health Services (Melville, NY)
    …why Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... additional clinical documentation. + Acts as liaison between the Utilization and Appeals Management Department and the physician of...care to MCC in response to physician order, or review of updated clinical information + Acts as a… more
    Catholic Health Services (07/24/25)
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  • RN Case Manager - Case Management…

    Guthrie (Corning, NY)
    …or, a Bachelor of Arts (BA) degree in addition to a degree in Nursing. A registered nurse with five (5) years relevant experience willing to pursue a BSN or ... In collaboration with the interdisciplinary healthcare team, the Case Manager will coordinate the flow of services throughout the...of hire. Individual consideration may be given to a registered nurse , with significant clinical experience, who… more
    Guthrie (09/23/25)
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  • Intake Coordinator- RN Lhtc/ Evenings

    Villa of Hope (Rochester, NY)
    …SUMMARY: Under the general direction of the Nurse Manager , the Intake Coordinator- RN is a Registered Nurse who will assist in supervising Clinical ... TITLE: Intake Coordinator- RN / Evening DEPARTMENT/PROGRAM: Medical Services SUPERVISOR: Nurse Manager /Health Coordinator PAY GRADE: 82 FLSA STATUS: NON… more
    Villa of Hope (08/09/25)
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  • Case Manager , RN (Commercial)

    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 (09/30/25)
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  • RN Unit Manager - Taylor Health

    Arnot Health (Bath, NY)
    …of all duties that may be assigned. EDUCATION: Current New York State Registered Nurse Licensure. BSN preferred. Certification in nursing specialty desirable. ... attends weekly care conference meetings, and weekly Medicare A review with care team and therapies. + Demonstrates effective...of the Long Term Care Department. + Ensures the utilization of the nursing process in maintaining quality of… more
    Arnot Health (07/28/25)
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  • RN /Case Manager -MSH-Case…

    Mount Sinai Health System (New York, NY)
    …+ Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ... **Job Description** ** RN /Case Manager MSH Case Management PT...a. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management… more
    Mount Sinai Health System (09/23/25)
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  • Medical Claim Review Nurse…

    Molina Healthcare (Rochester, NY)
    …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing… more
    Molina Healthcare (09/06/25)
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  • RN Lead, Healthcare Services

    Molina Healthcare (Buffalo, NY)
    …and at least 2 years of managed care experienced in utilization management * Registered Nurse ( RN ) ONLY if required by state contract, regulation or ... skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse ( RN ). License must be active and… more
    Molina Healthcare (09/26/25)
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  • Case Manager RN

    Bassett Healthcare (Oneonta, NY)
    …and enjoy the best quality of life possible. What you'll do The Case Manager RN supports the physician and interdisciplinary team in facilitating patient care, ... both areas. + Refers cases and issues to Case Review , Utilization Committee, Medical Director, and Director...setting, preferred Licensure/Certifications: + Current NYS licensure as a Registered Professional Nurse , if applying as a… more
    Bassett Healthcare (09/18/25)
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  • RN Case Manager

    Stony Brook University (Stony Brook, NY)
    RN Case Manager **Position Summary** At...the following but are not limited to:** + Completes Utilization review screen for inpatient and observation ... Stony Brook Medicine, a **TH Staff Associate/Case Manager ** is a valuable member of our team, who...other duties as required. **Qualifications** **Required** : Current NYS RN . A Bachelor's degree or a nurse … more
    Stony Brook University (07/16/25)
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