• Utilization Management Reviewer, RN…

    Excellus BlueCross BlueShield (Rochester, NY)
    …improving member and community health. + Manages more complex assignments; cross-trained to review various levels of care and/or services. + Participate in ... 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 (10/07/25)
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  • RN Supervisor for Emergency Observation…

    Trinity Health (Troy, NY)
    **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Nurse Supervisor for NEW ED Observation Unit at Samaritan Hospital** **Pavilion Building - ... 4T** **EXEMPT** **FT Days** If you are an experienced RN looking for a **_leadership_** position in the Observation/Clinical...your opportunity. Here at St. Peter's Health Partner's, we care for more people in more places. **Position Highlights:**… more
    Trinity Health (11/14/25)
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  • Case Manager, Medicaid Long Term Support Program

    MVP Health Care (Tarrytown, NY)
    At MVP Health Care , we're on a mission to create a...bring:** + Current New York State Licensure as a Registered Nurse required. + Certification in Case ... + An opportunity to shape the future of health care by joining a team recognized as a **Best...with an established interdisciplinary team. + The role requires review of a comprehensive assessment and development of a… more
    MVP Health Care (11/23/25)
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  • Supervisor, Utilization Management

    Centene Corporation (New York, NY)
    …of related experience. Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or ... Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day… more
    Centene Corporation (11/09/25)
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  • Denials Prevention Specialist, Clinician PRN

    Datavant (Albany, NY)
    …with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well...bring to the table:** + Two (2) years managed care experience in UM /CM/CDI Department preferred +… more
    Datavant (11/12/25)
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  • Appeals Manager

    BronxCare Health System (Bronx, NY)
    …special projects and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate ... appeals for the purpose of securing reimbursement for acute care services provided to patients. Assist in development of...submission in appeal. - In absence of Director, will review denial correspondence to determine validity of denial reason… more
    BronxCare Health System (09/19/25)
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  • Transplant Care Nurse (Remote)

    Highmark Health (Albany, NY)
    …and/or triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established ... in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced...in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or… more
    Highmark Health (11/06/25)
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  • Clinical Reviewer, Nurse…

    Evolent (Albany, NY)
    …people with most complex and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented health care ... system and ensure people get the same level of care and compassion we would want for our loved...Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Cardiology is responsible for support… more
    Evolent (11/20/25)
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  • Utilization Management Reviewer, Licensed…

    Excellus BlueCross BlueShield (Rochester, NY)
    …improving member and community health. + Manages more complex assignments; cross-trained to review various levels of care and/or services. + Participate in ... 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 (11/19/25)
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  • Manager Case Management

    Bassett Healthcare (Cooperstown, NY)
    …with departmental and institutional policies + Collaborates with the Director of Care Coordination on the development, review , and revision of policies ... collaboratively with unit staff (charge nurse , staff nurse ) unit manager, and support team ( UM ,...UM , MSW, SW, etc) to progress each patient's care towards discharge + Supports regional capacity management activities… more
    Bassett Healthcare (10/29/25)
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