• Nurse Case Manager - FT Days

    Nuvance Health (Poughkeepsie, NY)
    …BSN preferred. Must have current RN license. *Preferred Experience: * Utilization Review / Management .Company: Vassar Brothers Medical Center Org Unit: ... case from physiological and economic perspectives. Has overall accountability for the utilization management and transition management for patients within… more
    Nuvance Health (09/28/25)
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  • Clinical Assessment Manager - Care Delivery

    CenterLight Health System (Flushing, NY)
    …experience in care/case management , disease management , population health management , utilization review , quality assurance, or discharge planning ... systems License: Current active and unrestricted license in NYS as a Registered Nurse , required. Additional Requirements: + Be legally authorized (for example,… more
    CenterLight Health System (09/09/25)
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  • Manager, Healthcare Services

    Molina Healthcare (Buffalo, NY)
    …integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical ... identifying opportunities for improvement. **JOB QUALIFICATIONS** **Required Education** + Registered Nurse or equivalent combination of Licensed Vocational… more
    Molina Healthcare (09/27/25)
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  • RN - Case Manager - Full Time - Days

    Mohawk Valley Health System (Utica, NY)
    …regulatory compliance. Education/Experience Requirements Required: + Minimum of two (2) years utilization review /case management experience or social work ... RN - Case Manager - Full Time - Days Department: CASE MANAGEMENT Job Summary Reports to and is under direct supervision of Case Management Department.… more
    Mohawk Valley Health System (09/11/25)
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  • Care Review Clinician, Inpatient…

    Molina Healthcare (Albany, NY)
    …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At… more
    Molina Healthcare (09/25/25)
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  • RN Supervisor Case Management - Full…

    Mohawk Valley Health System (Utica, NY)
    …population. Provides direct oversight of the case manager's daily operations of utilization review practice, processes and procedures ensuring accurate member ... RN Supervisor Case Management - Full...Performs related duties as assigned. Education/Experience Requirements REQUIRED: + Registered Nurse licensed in State of New… more
    Mohawk Valley Health System (07/09/25)
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  • Intake Coordinator- RN Lhtc/ Evenings

    Villa of Hope (Rochester, NY)
    …JOB SUMMARY: Under the general direction of the Nurse Manager, the Intake Coordinator- RN is a Registered Nurse who will assist in supervising Clinical ... director of LHTC and administrative team, including billing and utilization review . + Triages potential admissions and...or leaving against medical advice. MINIMUM QUALIFICATIONS: + NYS Registered Nurse license + Bachelor degree preferred… more
    Villa of Hope (08/09/25)
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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 ... of hire. Individual consideration may be given to a registered nurse , with significant clinical experience, who...understanding of the regulatory requirements relative to the case management process. Certified to complete Patient Review … more
    Guthrie (09/23/25)
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  • Medical Claim Review Nurse…

    Molina Healthcare (Rochester, NY)
    …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
    Molina Healthcare (09/06/25)
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  • RN Clinical Manager

    CenterWell (Liverpool, NY)
    …license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home health ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...(NY state requirement) + Current state license as a Registered Nurse . + Proof of current CPR.… more
    CenterWell (09/27/25)
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