- Helio Health Inc. (Syracuse, NY)
- …track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our Inpatient, ... appropriate. + Assist in developing and administering policies and procedures for utilization . + Negotiating access to care for individuals seeking services at Helio… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Registered Nurse IDepartment: Utilization Management Location: Rochester General Hospital Hours Per Week: 40 hours (Full-Time)Schedule: Monday - Friday, ... as needed. Responsibilities include concurrent (as needed) and retrospective reviews. The Utilization Management Nurse will act as a resource on denial management as… more
- CVS Health (Albany, NY)
- …is a full-time, telework role. Schedule is Monday through Friday, 8am-5pm EST. Utilization Management is a 24/7 operation and work schedules will include weekends, ... opportunities to promote quality effectiveness of Healthcare Services and benefit utilization . + Consults and lends expertise to other internal and external… more
- WMCHealth (Valhalla, NY)
- Asst Utilization Coordinator Company: Westchester Medical Center City/State: Valhalla, NY Category: Nursing/Nursing Management Department: Clinical Care Management ... Applicant link Job Details: Internal Posting: 08/1/25 to 08/14/25 Assistant Utilization Coordinator Summary: Under general supervision, an incumbent of this class… more
- CVS Health (Albany, NY)
- …skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in clinically ... appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services for child and adolescent members. + Consults and… more
- Guidehouse (New York, NY)
- …on physician certification + Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis + Performs concurrent ... policies and timelines + Adheres to CMS guidelines for utilization reviews as evidenced by utilization of...guidelines for utilization reviews as evidenced by utilization of the relevant guidelines and appropriate referrals to… more
- Monroe Plan for Medical Care (Rochester, NY)
- Utilization Management Intake Representative II Summary Title: Utilization Management Intake Representative II ID:UM 42 (ROC) Location:Rochester, Buffalo, ... Syracuse, or Utica Job Type:Full-time Date Posted:07/24/2025 Openings:1 Department: Utilization Management Description Looking for meaningful work with an… more
- Catholic Health Services (Melville, NY)
- …Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals ... from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as… more
- University of Rochester (Rochester, NY)
- …Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500009 Utilization Management Work Shift: Range: UR URCB 213 Compensation Range: $69,326.00 - ... expertise of the individual, and internal equity considerations._ **Responsibilities:** The Utilization Management (UM) RN position spans the entire health care… more
- Molina Healthcare (Yonkers, NY)
- **Knowledge/Skills/Abilities** + Perform research and analysis of complex healthcare utilization and performance date, claims data, pharmacy data, and lab data ... regarding utilization and cost containment information. + Evaluate, write, and...cost containment information. + Evaluate, write, and present healthcare utilization and cost containment reports and makes recommendations based… more