• Analyst, Healthcare Ops - Remote GA

    Molina Healthcare (Albany, NY)
    …weekly/monthly/quarterly/annually standard reports. + Must have experience in analyzing Utilization management , member health risk assessment data using ... PowerBI + Must be able to collaborate with Executive teams in Utilization management , Operations, Core EIM teams. **JOB QUALIFICATIONS** **Required Education**… more
    Molina Healthcare (09/21/25)
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  • Health Insur & Auth Rep IV

    University of Rochester (Rochester, NY)
    …discharge. Identifies problems that include but are not limited to pre-certifications, Utilization Management , Medicaid Pending, third party payer issues, and ... communication and follow-up with assigned area, Financial Assistance, Social Work, Utilization Management , Medicaid Enrollment & Outreach, patients, families,… more
    University of Rochester (09/17/25)
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  • Medical Director - Mid West Region

    Humana (Albany, NY)
    …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
    Humana (09/16/25)
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  • Medical Director - Southeast Region

    Humana (Albany, NY)
    …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
    Humana (09/10/25)
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  • Director of Care Coordination (RN)

    Catholic Health Services (West Islip, NY)
    …hospital care management leadership role is required. + Experience in utilization management , working with managed care organizations, and discharge planning ... : + Works collaboratively with, but not limited to, Medical Staff, Quality/Risk Management , CH Utilization and Central Appeals, Managed Care and Revenue Cycle… more
    Catholic Health Services (07/18/25)
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  • Sr. Director, Client Analytics

    Evolent (Albany, NY)
    …public plans such as Medicaid is preferred. + Experience with value-based care, utilization management , or regulatory reporting (eg, HEDIS, NCQA, Milliman) is ... visualization, this role will collaborate cross-functionally to influence the effective utilization of data to deliver actionable insights, drive recommendations and… more
    Evolent (09/12/25)
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  • Senior Analyst, Client Analytics

    Evolent (Albany, NY)
    …insights to internal and external stakeholders. + Experience with value-based care, utilization management , or regulatory reporting (eg, HEDIS, NCQA, Milliman). ... : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, and population health opportunities using SAS, SQL, Excel, and Power… more
    Evolent (08/26/25)
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  • Medical Director - Northeast Region

    Humana (Albany, NY)
    …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
    Humana (07/25/25)
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  • RN Lead, Healthcare Services

    Molina Healthcare (Buffalo, NY)
    …healthcare services team supporting one or more of the following functions: care management , utilization management , care transitions, long-term services and ... health care, and at least 2 years of managed care experienced in utilization management * Registered Nurse (RN) ONLY if required by state contract, regulation or… more
    Molina Healthcare (09/26/25)
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  • Mental Health Program Specialist 2, Central…

    New York State Civil Service (Albany, NY)
    …adolescents with mental illness in a clinical capacity, as well as experience with utilization management and/or utilization review. ? The ideal candidate(s) ... will have direct care and utilization management experience, including familiarity with the review of medical evidence, psychiatric evidence, a knowledge base of… more
    New York State Civil Service (09/27/25)
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