• CHS Utilization and Appeals Coordinator

    Catholic Health Services (Melville, NY)
    …Utilization and Appeals Coordinator will perform activities to help facilitate utilization management and appeals functions to include coordination of ... payment related activities. Position Responsibilities: + Prepares necessary documentation for utilization management and appeals processes, performs data … more
    Catholic Health Services (09/09/25)
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  • Utilization Review Nurse

    Independent Health (Buffalo, NY)
    …Collaborative and Accountable. **Essential Accountabilities** Provide High Quality, Professional Utilization Management Services: (Medical necessity review for ... review.) + Prompt, courteous, professional and error free in performing utilization management functions. + Available to answer inbound phone calls within… more
    Independent Health (09/25/25)
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  • Utilization Review Nurse

    Albany Medical Center (Albany, NY)
    …Day (United States of America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management , Quality Screening and Delay Management for ... assigned patients. * Completes Utilization Management and Quality Screening for assigned patients.* Applies MCG criteria to monitor appropriateness of admissions… more
    Albany Medical Center (09/12/25)
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  • Utilization Review Nurse

    CDPHP (Latham, NY)
    …is required as a Registered Nurse. + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims processing is ... these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services… more
    CDPHP (09/23/25)
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  • Insurance Specialist-Mount Sinai West-…

    Mount Sinai Health System (New York, NY)
    …Excel and Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...EOW** To maintain front end operations of the Case Management Department by monitoring all incoming correspondence and ensuring… more
    Mount Sinai Health System (07/23/25)
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  • Utilization Case Manager- Inpatient Program

    Helio Health Inc. (Syracuse, NY)
    …Educate program staff on current principles and standards of practice surrounding utilization and denials management . + Use effective relationship management ... review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting ourSyracuse… more
    Helio Health Inc. (09/30/25)
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  • Utilization and Appeals Manager

    Catholic Health Services (Melville, NY)
    …from payors for additional clinical documentation. + Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as ... remain current with industry standards and business objectives related to Utilization and Care Management as appropriate. + Sound knowledge and skill in the use… more
    Catholic Health Services (07/24/25)
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  • Asst Utilization Coordinator

    WMCHealth (Valhalla, NY)
    …the implementation or investigation of the procedures specified in the Quality Management , Utilization Review and Discharge Planning Program at Westchester ... of which must have been in the area of utilization review, quality assurance, risk management or...area of utilization review, quality assurance, risk management or discharge planning. About Us: Westchester Medical Center… more
    WMCHealth (09/12/25)
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  • Assistant Director of Case Management

    Stony Brook University (Stony Brook, NY)
    …the following but are not limited to:** + Responsible for addressing Utilization management , denials and appeal, discharge and transition planning activities, ... Case Management leadership and staff functions regarding care management and utilization management activities. + Manages human resources utilization… more
    Stony Brook University (09/23/25)
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  • RN Acute Case Manager - System Care…

    Guthrie (Binghamton, NY)
    …recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with ... inpatient admissions and short procedures by translating clinical information to Utilization Management requirements using pre‐determined criteria. b. Documents… more
    Guthrie (08/27/25)
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