• RN UM Clinical Appeals Nurse…

    Molina Healthcare (Buffalo, NY)
    …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal...to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours:… more
    Molina Healthcare (11/14/25)
    - Related Jobs

  • Professional, Sub-Acute RN UM…

    MVP Health Care (Tarrytown, NY)
    …thinking and continuous improvement. To achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare** to join #TeamMVP. If you have a ... you'll bring:** + Current and unrestricted NY & VT RN licensure + Associate or bachelor's degree in nursing...+ Experience with electronic medical record (EMR) systems and UM platforms. + Familiarity with CMS regulations and appeals… more
    MVP Health Care (09/30/25)
    - Related Jobs

  • Care Review Clinician ( RN )

    Molina Healthcare (Buffalo, NY)
    For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications * At least...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
    Molina Healthcare (11/23/25)
    - Related Jobs

  • RN - FT Days Observation Unit - Samaritan…

    Trinity Health (Troy, NY)
    …to meet those needs **What you will need:** + A current license to practice as a Registered Nurse in the State of New York + ASN required, BSN preferred from an ... on M/S units. Will work closely with Hospitalist and CM/ UM assigned to unit. Here at St. Peter's Health...that the plan of care is evaluated + The RN is directly accountable to the Nurse … more
    Trinity Health (09/13/25)
    - Related Jobs

  • RN Care Review Clinician Remote

    Molina Healthcare (Albany, NY)
    …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical...the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. **Required Qualifications** * At least… more
    Molina Healthcare (11/21/25)
    - Related Jobs

  • Care Review Clinician, PA ( RN )

    Molina Healthcare (Rochester, NY)
    …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. **Preferred… more
    Molina Healthcare (10/26/25)
    - Related Jobs

  • Care Review Clinician ( RN )

    Molina Healthcare (Syracuse, NY)
    …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications * At least 2 years experience,… more
    Molina Healthcare (11/21/25)
    - Related Jobs

  • Care Review Clinician ( RN )

    Molina Healthcare (NY)
    …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications * At least 2 years experience,… more
    Molina Healthcare (11/21/25)
    - Related Jobs

  • Case Manager, RN or Licensed Behavioral…

    Excellus BlueCross BlueShield (Rochester, NY)
    …varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, ... Associates degree required. Bachelor's degree preferred. + Active NYS RN or Registered Dietician or Physical Therapist...Certification required + Broad understanding of multiple areas (ie UM and CM). At this level, incumbent is required… more
    Excellus BlueCross BlueShield (11/20/25)
    - Related Jobs

  • RN Case Manager

    Stony Brook University (Stony Brook, NY)
    …and other duties as required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN license and working history ... RN Case Manager **Position Summary** At Stony Brook...their work and follow up with cases. **Preferred:** CM, UM , Quality, Coding, Risk or MCG Certification Working knowledge… more
    Stony Brook University (10/23/25)
    - Related Jobs