• Utilization Review Nurse

    Independent Health (Buffalo, NY)
    …perks, benefits and a culture that fosters growth, innovation and collaboration. **Overview** The Utilization Review Nurse (URN) performs clinical review ... required; Bachelor's degree preferred. Current, active, unrestricted, and licensed registered nurse ( RN ) required. +... in a varied clinical setting required. + Previous utilization review experience preferred. + Previous experience… more
    Independent Health (09/25/25)
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  • RN Case Manager - Case…

    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...an 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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  • Case Manager, RN (Commercial)

    Excellus BlueCross BlueShield (Rochester, NY)
    …varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, ... of consistent and quality health care services. Examples may include: Utilization Management, Quality, Behavioral Health, Pharmacy, Registered Dietitian and… more
    Excellus BlueCross BlueShield (09/30/25)
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  • RN Case Manager

    Stony Brook University (Stony Brook, NY)
    RN Case Manager **Position Summary** At...the following but are not limited to:** + Completes Utilization review screen for inpatient and observation ... Stony Brook Medicine, a **TH Staff Associate/ Case Manager** is a valuable member of our team,...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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  • Case Manager - RN

    Calvary Hospital (Bronx, NY)
    …Spending, Transit Check. + Free On-Site Parking Requirements Participates in the Utilization Review , Discharge Planning, Risk Management, and Quality Assessment ... Location: Bronx Campus Salary: $63.1783 hourly Status: Part-Time Qualifications: + Registered professional nurse , current unencumbered NYS licensure. + Five… more
    Calvary Hospital (09/11/25)
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  • RN Clinical Manager

    CenterWell (Westbury, NY)
    …action through the utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case Managers and clinical staff ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
    CenterWell (09/30/25)
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  • Medical Claim Review Nurse…

    Molina Healthcare (Rochester, NY)
    …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing… more
    Molina Healthcare (09/06/25)
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  • RN Lead, Healthcare Services

    Molina Healthcare (Buffalo, NY)
    …and at least 2 years of managed care experienced in utilization management * Registered Nurse ( RN ) ONLY if required by state contract, regulation or ... skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse ( RN ). License must be active and… more
    Molina Healthcare (09/26/25)
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  • RN - HIV Medicine Office

    Albany Medical Center (Albany, NY)
    …Aids Program Work Shift: Day (United States of America) Salary Range: $83,200.00 - $128,960.00 Registered Nurse ( RN ) - Full time HIV Medicine Clinic - ... advanced practice provider (APP) and the supervision of the Nurse Manager ( RN ) and/or Nurse ...Nursing program is required* Current NYS license as a Registered Nurse Thank you for your interest… more
    Albany Medical Center (08/22/25)
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  • RN -Education Spec-Clin Center for Learning…

    Albany Medical Center (Albany, NY)
    …Experience in the field of Clinical Social Work or Nursing with experience in Case Management, Utilization Review and Discharge Planning. * BLS ... principles of conflict resolution and promote consensus building.* Represents Case Management/Social Work at organizational committee meetings as directed* Serves… more
    Albany Medical Center (09/01/25)
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