• Commercial Review Specialist I

    SUNY Upstate Medical University (Syracuse, NY)
    …preparing regulatory notices for delivery to the patient Minimum Qualifications: NYS Licensed/ Registered (or eligible) RN , Bachelor's Degree in Nursing, and a ... This is achieved through a thorough chart review and utilization of first-level screening criteria to ensure patients are...minimum of three years post RN licensure acute care nursing experience, or Associate's Degree… more
    SUNY Upstate Medical University (11/18/25)
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  • Transplant Care Nurse (Remote)

    Highmark Health (Albany, NY)
    …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or… more
    Highmark Health (11/06/25)
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  • Denials and Appeals Mngmt Cord

    WMCHealth (Valhalla, NY)
    …the results. + Maintains familiarity with the laws, regulations, and interpretation of utilization review and discharge planning. Remains up to date on changes in ... + Performs any other duties as assigned. Qualifications/Requirements: Experience: Education: RN , Graduate of an accredited school of Nursing Experience: Five (5)… more
    WMCHealth (10/17/25)
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  • Admissions/Discharge Nurse

    Bassett Healthcare (Cooperstown, NY)
    …and enjoy the best quality of life possible. What you'll do The Discharge Nurse is accountable for the delivery of safe patient care utilizing the nursing process. ... The Discharge Nurse assesses, plans, delivers, coordinates, integrates, and evaluates nursing...and managerial observation + Demonstrates consideration of safety, effective utilization of equipment and materials, and cost in managing… more
    Bassett Healthcare (11/03/25)
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  • Clinical Case Manager

    SUNY Upstate Medical University (Syracuse, NY)
    …coordinating, facilitating and monitoring resources to achieve optimal clinical outcomes, utilization of services, and financial goals. The Clinical Case Manager ... appropriate discharge plan/plan of care. Minimum Qualifications: NYS licensed RN (or eligible), Bachelor's degree in Nursing or a...plus a minimum of three (3) years acute care RN or acute care, transitional care, or chronic care… more
    SUNY Upstate Medical University (08/26/25)
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  • VP, Clinical Operations

    Molina Healthcare (Buffalo, NY)
    …LICENSE, CERTIFICATION, ASSOCIATION:** + Active, unrestricted State Registered Nursing ( RN ) license in good standing. + Utilization Management Certification ... key medical management initiatives and analytical studies aimed at optimizing utilization of medical resources and maximizing operational efficiencies. + Engages… more
    Molina Healthcare (10/26/25)
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  • Director-Care Mgmt

    Catholic Health Services (Roslyn, NY)
    …Then you have what it takes to be a St. Francis Hospital & Heart Center(R) RN . You are at the heart of health. St. Francis Hospital, The Heart Center(R) is New ... compliance with regulatory and external review agencies. + Participates in the Utilization Management Committee, reporting data on utilization trends, resource … more
    Catholic Health Services (10/10/25)
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  • Nurse Case Manager - FT Days

    Nuvance Health (Poughkeepsie, NY)
    …have Associate's Degree in Nursing, BSN preferred. Must have current RN license. *Preferred Experience: * Utilization Review/Management.Company: Vassar Brothers ... Discharge Planning primarily Under the general supervision of the Director, The Nurse Case Manager role provide clinically-based case management to support the… more
    Nuvance Health (09/28/25)
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  • Patient Care Coordinator

    Kaleida Health (Buffalo, NY)
    …Basic Life Support (BLS) required upon hire. Current NYS registration as a Registered Professional Nurse / RN Permit and American Heart Association-Basic Life ... outcomes.** **Education And Credentials** Current New York State registration as a Registered Professional Nurse required. Bachelor of Science degree in Nursing… more
    Kaleida Health (10/19/25)
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  • Appeals Nurse - Behavioral Health

    Actalent (New York, NY)
    …Essential Skills + LPN with 3+ years of clinical nursing experience or RN with 2+ years of clinical nursing experience. + Proficiency with Microsoft Office ... applications. + Experience with utilization or appeals review. + Knowledge of InterQual criteria. + RN or LPN license. Additional Skills & Qualifications + NYS … more
    Actalent (11/18/25)
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