• Medical Social Worker

    Albany Medical Center (Albany, NY)
    …and evaluation of services to patients and families + Collaborate with Risk Management , Patient Relations, Utilization Management , and Quality Management ... Department/Unit: Care Management /Social Work Work Shift: Day (United States of America) Salary Range: $65,102.17 - $100,908.37 Medical Social Worker Create optimal… more
    Albany Medical Center (09/12/25)
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  • Social Work Care Manager

    Elderwood (Buffalo, NY)
    …may require interventions. + Participate in Interdisciplinary Team meetings, Disease Management , Utilization Management , and Quality Improvement activities ... health care related issues + Provide discharge planning and continuous care management across care settings and coordinate the transition planning + Participate in… more
    Elderwood (08/16/25)
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  • Major & Strategic Account Executive - Hospital…

    Wolters Kluwer (Albany, NY)
    …including: + Conducting regular account review meetings and reviewing account utilization management reporting to provide recommendations + Overseeing contract ... + Closely managing the deal through closure and keeping management informed of any risks or delays + Retaining...level and other key decision makers + Excellent account management skills and ability to manage external and internal… more
    Wolters Kluwer (07/24/25)
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  • Behavioral Health Care Manager II

    Elevance Health (New Hyde Park, NY)
    …services only, and there is licensed staff supervision. + Previous experience in case management / utilization management with a broad range of experience with ... offers superior clinical mental health and substance use disorder management , a comprehensive employee assistance program, work/life support, specialty programs… more
    Elevance Health (09/30/25)
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  • Community Health Assessment Field Nurse (Rochester…

    Excellus BlueCross BlueShield (Rochester, NY)
    …assignments, difficult members and highly visible issues. + Understanding of the basic Utilization Management and Case Management aspects of the department ... attendance is expected and required. + Performs other functions as assigned by management . Minimum Qualifications: + RN with valid and current NYS Nursing Licensure.… more
    Excellus BlueCross BlueShield (09/27/25)
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  • Senior Manager, Project Manager, Aetna Medicare…

    CVS Health (Albany, NY)
    …Lead the day-to-day operations of key business projects and programs around utilization management (UM), clinical programs, and pharmacy operations. + ... user of Excel, PowerPoint, Word **Preferred Qualifications:** + Project management certification. **Education:** + Bachelor's degree preferred or a combination… more
    CVS Health (09/25/25)
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  • Manager, Clinical Data Acquisition (Remote)

    Molina Healthcare (Albany, NY)
    …use of information from multiple sources, including claims/encounters, pharmacy, utilization management , clinical indicators, industry benchmark, and/or ... & ABILITIES:** * 7+ years experience in managed healthcare Quality/HEDIS project management and HEDIS Audit * Demonstrated knowledge of and experience with HEDIS… more
    Molina Healthcare (08/31/25)
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  • Mobile Professional Care Manager (Hybrid)

    UPMC (Jamestown, NY)
    …Nurse. + Minimum of 3 years of experience in behavioral health, clinical care, utilization management , home care, discharge planning, or case management . + ... 5 years of experience in community-based case management and behavioral health _preferred_ . + General knowledge of best practices for working with special needs… more
    UPMC (08/30/25)
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  • Leader, Concurrent Review

    MVP Health Care (Schenectady, NY)
    …+ Minimum 4 years of clinical nursing experience. + At least 2 years in utilization management sub-acute care review. + 2+ years of supervisory experience + ... team at ###@mvphealthcare.com . **Job Details** **Job Family** **Medical Management /Clinical** **Pay Type** **Salary** **Hiring Min Rate** **56,200 USD** **Hiring… more
    MVP Health Care (09/30/25)
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  • Residential SUD Counselor - 127 West 25th Street

    Bowery Residents Committee (Manhattan, NY)
    …plans, and crisis intervention. Gather and review documentation as requested for utilization management reviews of clients on caseload including completion of ... MSW or CASAC-T License required. LMHC or LMSW preferred. Excellent time management skills. Bachelors strongly preferred. Knowledge of OASAS rules and regulations and… more
    Bowery Residents Committee (09/30/25)
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