• Workforce Management Professional

    Humana (Albany, NY)
    …Workforce Management team, supporting the Medicaid Inpatient and Outpatient Utilization Management segment. This role is responsible for executing ... our caring community and help us put health first** The Workforce Management Professional 2 applies and integrates advanced and predictive analysis, people metrics… more
    Humana (11/20/25)
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  • Senior Project Manager, Medical Management

    CVS Health (Albany, NY)
    …stakeholder engagement, and workflow optimization. + Familiarity with healthcare regulations, utilization management , case management , and general medical ... Senior Project Manager to lead clinical-focused initiatives supporting our Medical Management team. This role goes beyond traditional project management -it… more
    CVS Health (11/20/25)
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  • Case Manager RN

    Bassett Healthcare (Cooperstown, NY)
    …timely and accurate information to payors. The role integrates and coordinates utilization management , care facilitation, and discharge planning functions. The ... barriers to efficient delivery of care in appropriate setting. + Completes utilization management and quality screening for assigned patients. + Applies… more
    Bassett Healthcare (11/07/25)
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  • Nursing RN Case Management - Walk…

    Trinity Health (Troy, NY)
    …experience in acute setting **Preferred requirements:** + 1+ year of experience in case management or utilization management + Case Management ... Engage the patient and care team in the joint management of key patient outcomes such as management of disease progression, continued LOS and transition to most… more
    Trinity Health (10/30/25)
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  • Transitional Care RN - Case Management

    Mohawk Valley Health System (Utica, NY)
    …+ 3 years of clinical experience. + Strong computer skills. PREFERRED: + Case Management , Utilization Management and Quality Management experience ... Transitional Care RN - Case Management - Full Time - Days Department: CASE MANAGEMENT Job Summary The RN - Transitional Care Coordinator is responsible for… more
    Mohawk Valley Health System (10/07/25)
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  • Field Medical Director, Interventional Cardiology…

    Evolent (Albany, NY)
    …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to ... meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use… more
    Evolent (10/29/25)
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  • Pharmacist - Case and Disease Management

    Highmark Health (Albany, NY)
    …residency program + 5 - 7 years in Pharmacy + 3 - 5 years in Pharmacist - Utilization Management + 3 - 5 years in Pharmacist - Medical Therapy Management ... to medication therapy are transitioned to a Pharmacist for Case & Disease Management (CMDM). The incumbent then conducts thorough research to evaluate the patient… more
    Highmark Health (11/15/25)
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  • Pharmacy Prior Authorization Technician

    Excellus BlueCross BlueShield (Rochester, NY)
    …and procedures. This position accurately prepares and interprets cases for UM ( utilization management ) reviews and determination. In addition, the Technician is ... ensure delivery of consistent and quality health care services examples include Utilization Management , Quality Management and Case Management . +… more
    Excellus BlueCross BlueShield (11/19/25)
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  • Case Manager , RN (FH)

    Northwell Health (Forest Hills, NY)
    …2. are appropriately arranged for and financially approved.Performs concurrent utilization management .Reviews appropriateness of patient's admission, need for ... (5) years clinical experience as a registered nurse. Prior experience in utilization management and/or discharge planning, preferred. A strong clinical… more
    Northwell Health (11/07/25)
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  • Medical Director, Behavioral Health

    Molina Healthcare (Buffalo, NY)
    …**Job Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental ... care management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization management and case management programs for… more
    Molina Healthcare (10/17/25)
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