• Care Review Clinician (RN)

    Molina Healthcare (NY)
    …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.… more
    Molina Healthcare (11/21/25)
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  • Field Medical Director, Oncology

    Evolent (Albany, NY)
    …Doing:** As a Field Medical Director, Oncology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. .… more
    Evolent (11/18/25)
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  • Field Medical Director, Radiology (Neurology)

    Evolent (Albany, NY)
    …Doing:** Job Description As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
    Evolent (10/31/25)
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  • Case Manager (Inpatient Units)

    Ellis Medicine (Schenectady, NY)
    …Services discharge planning guidelines and departmental/organizational policies and processes + Utilization Management : + Ensures order in chart/EMR coincides ... services provided by the Case Manager include, but are not limited to, utilization review, case management , care transition, collaboration with physicians and… more
    Ellis Medicine (10/24/25)
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  • Care Facilitator- Canton-Potsdam Hospital, Potsdam

    Rochester Regional Health (Rochester, NY)
    …efficient utilization of resources. Carries out activities related to utilization management , discharge planning, care coordination and referral to other ... York State as a Registered Nurse PREFERRED QUALIFICATIONS: + Case Management or Utilization Management experience + Bachelor's Degree EDUCATION: LICENSES /… more
    Rochester Regional Health (09/19/25)
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  • Medical Director - Nat'l UM IP (4x10 hr)

    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 (11/07/25)
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  • Medical Director - Claims Mgmt (Remote)

    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 (11/01/25)
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  • Medical Director - Medicaid N. Central

    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 (10/25/25)
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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 (10/18/25)
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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 (10/16/25)
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