• Registered Nurse (RN) - Utilization

    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 - ... needed. Responsibilities include concurrent (as needed) and retrospective reviews. The Utilization Management Nurse will act as a resource on denial … more
    Rochester Regional Health (08/02/25)
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  • Utilization Management Intake…

    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
    Monroe Plan for Medical Care (07/25/25)
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  • Utilization Management Nurse…

    CVS Health (Albany, NY)
    …This 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 ... med surg or specialty area + Managed Care experience preferred, especially Utilization Management + Preference for those residing in EST zones **Education** +… more
    CVS Health (08/02/25)
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  • Utilization Management RN

    Guidehouse (New York, NY)
    …nursing. + New York Nursing License - REQUIRED + 4+ years of experience in utilization management + Familiarity with MCG and InterQual guidelines + Ability to ... certification + Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis...policies and timelines + Adheres to CMS guidelines for utilization reviews as evidenced by utilization of… more
    Guidehouse (07/25/25)
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  • RN, Utilization Management

    University of Rochester (Rochester, NY)
    …Subtype: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500009 Utilization Management Work Shift: Range: UR URCB 213 Compensation Range: ... expertise of the individual, and internal equity considerations._ **Responsibilities:** The Utilization Management (UM) RN position spans the entire health… more
    University of Rochester (08/07/25)
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  • Utilization Management

    Mount Sinai Health System (New York, NY)
    **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing… more
    Mount Sinai Health System (07/12/25)
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  • Medical Director, Post-Acute Care…

    MVP Health Care (Schenectady, NY)
    …improvement. To achieve this, we're looking for a **Medical Director, Post-Acute Care Utilization Management ** to join #TeamMVP. If you have a passion for ... reviews, continued stay requests, and handling first-level appeals. + Collaborate with Utilization Management , Case Management , Quality Department and other… more
    MVP Health Care (08/09/25)
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  • Utilization Management Nurse

    CenterWell (Albany, NY)
    …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
    CenterWell (08/08/25)
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  • Utilization Management Nurse

    CenterWell (Albany, NY)
    …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
    CenterWell (08/02/25)
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  • Utilization Management

    Elevance Health (Latham, NY)
    ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... unless an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible for coordinating cases for… more
    Elevance Health (08/08/25)
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