• Public Health Program Nurse (NY Helps)

    New York State Civil Service (Albany, NY)
    …be asked for their social security number to verify eligibility. Current registration as a Registered Nurse ( RN ) with the New York State Education Department ... New York State license and registration as a professional registered nurse AND four years of post-licensure...but are not limited to: Experience in discharge planning, utilization review , treatment plan development for individuals… more
    New York State Civil Service (11/13/25)
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  • Nurse Case Manager: Full Time, DAYS

    Albany Medical Center (Albany, NY)
    …of computer systems with skills applicable to utilization review process. + RN - Registered Nurse - State Licensure and/or Compact State Licensure ... works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to… more
    Albany Medical Center (11/03/25)
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  • Quality Management Specialist I

    DePaul (Rochester, NY)
    …Quality Management planning. + Performs all other duties as assigned. Qualifications + Registered Nurse or Licensed Practical Nurse with 3 years of ... Management Plan within the corporation. + Incident Management - review incident reports and provide...reporting and follow-up consultation and training. + Responsible for Utilization Record Review functions to include Individual… more
    DePaul (10/10/25)
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  • Clinical Program Manager - Clinical Command Center…

    Mount Sinai Health System (New York, NY)
    …patient emergencies and supporting patient-centered care. **Qualifications** Must be a Licensed Registered Nurse , Physician Assistant or Nurse Practitioner ... 4. One (1) year of Patient Flow experience preferred 5. EPIC experience preferred. Registered Nurse Licensed NYS Registered Professional Nurse … more
    Mount Sinai Health System (11/08/25)
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  • Healthcare Clinical Documentation Specialist

    Deloitte (New York, NY)
    …Bachelor's degree in nursing, medical degree, or physician assistant required + Current Registered Nurse ( RN ) license required + Certified Clinical ... nurse , physician, physician assistant, case manager, clinical documentation specialist, utilization review , informatics RN , Quality, DRG Validation and… more
    Deloitte (11/21/25)
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  • Denials Prevention Specialist, Clinician PRN

    Datavant (Albany, NY)
    …job function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of...expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more
    Datavant (11/12/25)
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  • Nurse Manager, Ambulatory Services

    Rochester Regional Health (Rochester, NY)
    …LICENSES / CERTIFICATIONS: BLS - Basic Life Support - American Heart Association (AHA), RN - Registered Nurse - New York State Education Department ... Job Title: Nurse Manager, Ambulatory ServicesDepartment: Pulmonary, Sleep Lab, Infectious...of Nursing and Director of Quality to provide quality review activities. Guides assigned areas in utilization … more
    Rochester Regional Health (10/14/25)
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  • Professional, Behavioral Health

    MVP Health Care (Tarrytown, NY)
    …Master's prepared and licensed mental health clinician (LMSW, LCSW, LMHC, etc.) or Licensed Registered Nurse ( RN ) required + New York State license required ... with at least 2 years being ASD related + Utilization or Case Management experience in a...our customers in every interaction **Your key responsibilities:** + Review all requests for behavioral health services utilizing the… more
    MVP Health Care (11/21/25)
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  • VPS Psychiatric Nurse Practitioner

    City of New York (New York, NY)
    …requirement above, candidates must have three years of full-time satisfactory experience as a Registered Nurse , two of which must have been in a supervisory ... with the referring agency and the client's caseworker. 2. Review all available clinically relevant material, including referral information,...have three years of full-time satisfactory experience as a Registered Nurse , one of which must have… more
    City of New York (11/07/25)
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  • Payment Integrity Clinician

    Highmark Health (Albany, NY)
    …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more
    Highmark Health (11/14/25)
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