• Clinical Assessment Manager

    Actalent (Queens, NY)
    …& Qualifications + Experience with care/ case management , disease management , population health management , utilization review, quality assurance, or ... Current active and unrestricted license in NYS as a Registered Nurse . + Medically cleared for communicable...interpersonal skills. + Customer service oriented with strong clinical management skills. + Minimum of one year of experience… more
    Actalent (04/22/25)
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  • Quality Assurance Senior Coordinator--UR

    SUNY Upstate Medical University (Syracuse, NY)
    …field) and a minimum of three years RN post-licensure nursing experience or RN Utilization Management , or Associate's Degree in Nursing and five years ... and the development of new programs/processes. Responsible for working with the Case Management to ensure the appropriate application of Interqual Criteria… more
    SUNY Upstate Medical University (03/10/25)
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  • Patient Care Coordinator

    Kaleida Health (Williamsville, NY)
    …acute care Nursing Experience required. 2 years of experience in any combination of case management , home care and utilization review preferred. Knowledge of ... outcomes for the patient in the acute care setting. Case management is a process that efficiently...(BLS) required upon hire. Current NYS registration as a Registered Professional Nurse / RN Permit and… more
    Kaleida Health (03/20/25)
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  • Clinical Admissions Facilitator for Sunnyview…

    Trinity Health (Schenectady, NY)
    …clinical assessment **What you will need:** **Must have Active Licensure as a Registered Nurse , Occupational Therapist, or Physical Therapist** **A minimum of 2 ... members, referral sources, and external payers regarding the effective and efficient utilization of program services and available resources. + Screening of clients… more
    Trinity Health (03/25/25)
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  • Patient Management Supervisor

    Kaleida Health (Williamsville, NY)
    …of Microsoft Office Suite and Outlook. 2 years of experience In any combination of: case management , home care and utilization review preferred. Knowledge of ... **Patient Management Supervisor** **Location:** Millard Fillmore Suburban **Location of...Nursing required. Bachelors or Masters in Social Work preferred. RN Licensure required. **Experience** **2 years of experience in… more
    Kaleida Health (05/03/25)
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  • Transition of Care Associate - Licensed Practical…

    CVS Health (Albany, NY)
    …TOC team will review prior claims to address potential impact on current case management and eligibility status. Focus assessments and/or questionnaires are ... impact on our members, who are enrolled in Care Management and present with a wide range of complex...nursing, or rehabilitative stay. Under the direction of a Registered /Licensed RN , the TOC Coach ensures the… more
    CVS Health (05/03/25)
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  • Clinical Nurse Manager

    OrthoNY (Clifton Park, NY)
    … (payroll, coaching, corrective action and performance appraisals); + Assist with management of physician block time including evaluating utilization and making ... We are seeking a motivated Clinical Nurse Manager to support the Director of Ambulatory...schedule and coordinate staff breaks and lunches; + Monitor case progress and times, respond to issues to minimize… more
    OrthoNY (04/29/25)
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  • VP, Healthcare Services in Georgia

    Molina Healthcare (NY)
    Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... the state health plan's Healthcare Services (clinical operations) teams including Utilization Management (prior-authorization, inpatient review) and Care … more
    Molina Healthcare (04/20/25)
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  • Social Worker - Inpatient Behavioral Health

    Garnet Health (Harris, NY)
    …Health Medical Center - Catskills Emergency Department. Additionally will provide case management , and discharge planning for non-psychiatric patients. The ... as necessary. Maintaining administrative records related to emergency evaluations and case management . Close collaboration with ED physician and other… more
    Garnet Health (02/25/25)
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  • Associate Manager, Clinical Health Services

    CVS Health (Albany, NY)
    …the oversight of Long-Term Services and Supports (LTSS) and Waiver healthcare case management staff, including progressing initiatives for high-performing health ... essential for monitoring, training, oversight and compliance for the Utilization Management Team which is responsible for...least 1 year in a leadership position + Requires RN License, and specialized knowledge and expertise from entry… more
    CVS Health (04/16/25)
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