• Payment Integrity Clinician

    Highmark Health (Albany, NY)
    …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
    Highmark Health (11/14/25)
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  • Nurse Manager

    Ellis Medicine (Schenectady, NY)
    …standards and regulatory requirements. Requirements: Currently licensed in New York State as a Registered Nurse and a graduate of an approved school of nursing. ... Basic Function: The Nurse Manager (NM) actualizes the vision, mission and...nursing care delivery system to assure effective and efficient utilization of staff and other resources for the delivery… more
    Ellis Medicine (11/13/25)
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  • Assistant Nurse Manager - Nursing Unit - 2…

    Guthrie (Corning, NY)
    …care role related to professional specialty. Education, License & Cert: Licensed as a Registered Nurse in the State of practice. Certification within area of ... hire. Experience: Two years of recent clinical supervisory experience or charge nurse experience desired Essential Functions: 1.RESOURCE UTILIZATION : + Considers… more
    Guthrie (11/11/25)
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  • Case Manager - AOMC

    Arnot Health (Elmira, NY)
    …of an approved registered nursing program with a current license as a registered nurse . BSN or Case Management Certification preferred. EXPERIENCE: Three to ... . The Case Manager will review all patients for utilization management and appropriate discharge planning. The Case Manager's...The Case Manager tracks and trends LOS , resource utilization , outliers, readmissions , denials , delay days… more
    Arnot Health (11/06/25)
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  • Supv, Asst Clinical Manager CH

    Guthrie (Corning, NY)
    …school of Nursing. Bachelor's degree in nursing is required. Licensed as a Registered Nurse in state of practice Certification within area of expertise ... dependentExperience: Two years of recent clinical leadership experience or charge nurse experience desired. Essential Functions: 1. RESOURCE UTILIZATION :… more
    Guthrie (10/30/25)
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  • AVP of OR/Peri-Op Services

    Albany Medical Center (Albany, NY)
    …or related field. Licensure, Certification & Registration: + Must hold a current NYS Registered Nurse license. Experience: + 7-10 years of experience in nursing, ... Responds to changes in work efficiently and effectively. Support implementation and utilization of clinical nursing research. Promote the use by colleges and… more
    Albany Medical Center (09/27/25)
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  • Director Pre Appeals Management-HSO Appeals…

    Mount Sinai Health System (New York, NY)
    …Business, or related field strongly preferred + **Licensure/Certification** : + Active RN license in the state of employment required + Certification in Case ... Management (CCM, ACM) or Utilization Management preferred. + 7+ years of experience in...+ 7+ years of experience in clinical acute clinical, utilization management, appeals management or related operations + 3+… more
    Mount Sinai Health System (11/01/25)
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  • Clinical Resources Manager Physician Practice

    UHS (Vestal, NY)
    …expert training License/Certification Minimum Required: + Current New York State license as a Registered Nurse + CPR within 3 months of hire Preferred: + ... the highest standards of patient care through effective resource coordination and utilization . In this role, you'll collaborate with clinical teams to manage… more
    UHS (11/15/25)
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  • Senior Clinical Strategist

    CVS Health (Albany, NY)
    …Operations and others on initiatives for Stars/quality improvement **Required Qualifications** - Registered Nurse with active and unrestricted license in state ... primarily impact Stars and quality but will also focus on improvements in utilization and cost. The Senior Clinical Strategist works to drive clinical performance of… more
    CVS Health (11/14/25)
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  • Virtual Care Coordinator-Works Onsite at Mt Sinai…

    Mount Sinai Health System (New York, NY)
    …ensure safety, and prevention of falls and injury as directed by the patient's registered nurse . 12. Sets priorities, problem solves and uses proper judgment in ... problem solves and uses proper judgment in difficult situations. 21. Submits utilization and assignment report every shift to supervisor and site nursing leadership.… more
    Mount Sinai Health System (11/13/25)
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