• LPN - Wellness

    Guthrie (Binghamton, NY)
    …in nursing practice. + Preferred experience with care management / utilization review , and payer knowledge. + RN considered. Education: + Completion of an ... to a $15,000.00 Sign on Bonus!! Summary: The Wellness Nurse plays a key role in health promotion and...to health promotion and illness prevention, as well as management of chronic conditions. + Educates patients and their… more
    Guthrie (09/26/25)
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  • Logistics RN Bed Management

    Bassett Healthcare (Cooperstown, NY)
    …nursing experience, required Licensure/Certifications: + Current NYS Licensure as a Registered Professional Nurse , required Physical Requirements: + Light work: ... a bariatric bed, special equipment, interpreter svc, etc.). + Review previous patient history and updates CL with key...or be suspended at any time. Bonus Amount: + RN (excluding management ) sign-on bonuses are awarded… more
    Bassett Healthcare (09/09/25)
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  • Director of Patient Services, Homecare RN…

    The New Jewish Home (Bronx, NY)
    …job functions.) Job Qualifications: + Current license and registration to practice as a Registered Nurse in New York State. + Bachelor's Degree in Nursing. + ... Monitors quality of care delivered by staff through record review , conferences, supervisory visits and review of...the latest internal and external issues and trends in utilization and quality management through select committee… more
    The New Jewish Home (09/24/25)
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  • Case Manager - RN

    Calvary Hospital (Bronx, NY)
    …Flex Spending, Transit Check. + Free On-Site Parking Requirements Participates in the Utilization Review , Discharge Planning, Risk Management , and Quality ... unencumbered NYS licensure. + Five (5) or more years experience in either Utilization Management , Quality Assessment and Improvement, Risk Management , and/or… more
    Calvary Hospital (09/11/25)
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  • Case Manager RN

    Bassett Healthcare (Oneonta, NY)
    …timely and accurate information to payors. The role integrates and coordinates utilization management , care facilitation, and discharge planning functions. The ... barriers to efficient delivery of care in appropriate setting. + Completes utilization management and quality screening for assigned patients. + Applies… more
    Bassett Healthcare (09/18/25)
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  • RN Case Manager

    Stony Brook University (Stony Brook, NY)
    … Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...other duties as required. **Qualifications** **Required** : Current NYS RN . A Bachelor's degree or a nurse … more
    Stony Brook University (07/16/25)
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  • RN Clinical Appeals Nurse

    Molina Healthcare (Yonkers, NY)
    …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
    Molina Healthcare (09/26/25)
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  • Professional, Sub-Acute RN UM Reviewer…

    MVP Health Care (Tarrytown, NY)
    …of clinical nursing experience + At least 2 years of experience in utilization management of sub-acute Medicare reviews + Experience with Medicare guidelines ... To achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare** to join #TeamMVP. If...interdisciplinary teams to ensure optimal patient care and resource utilization . + Document review outcomes and maintain… more
    MVP Health Care (09/30/25)
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  • Primary Care Physician (PCP) - PRN

    STG International (Auburn, NY)
    …in quality improvement, care management , risk management , peer review , utilization review , clinical outcomes, and health enhancement activates. ... Performance Improvement Team (QPIT) strategic initiatives. * Participate in review and improvement of clinical success in of areas...of the clinic's day-to-day activity, in conjunction with the Registered Nurse ( RN )/CBOC Manager and… more
    STG International (09/26/25)
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  • Primary Care Physician (PCP)

    STG International (Kingston, NY)
    …in quality improvement, care management , risk management , peer review , utilization review , clinical outcomes, and health enhancement activities ... Performance Improvement Team (QPIT) strategic initiatives. + Participate in review and improvement of clinical success in areas of...of the clinic's day-to-day activity, in conjunction with the Registered Nurse ( RN )/CBOC Manager and… more
    STG International (07/09/25)
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