• Intake Coordinator

    Highmark Health (Buffalo, NY)
    …Description :** **JOB SUMMARY** This job captures all inbound inquires for utilization management review from providers and pharmacies. The incumbent assesses ... member, and then creates the case (data entry) in Highmark's Utilization Management system for Prior Authorization clinical review. Ensures all accurate… more
    Highmark Health (09/27/25)
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  • RN Clinical Appeals Nurse

    Molina Healthcare (Yonkers, NY)
    …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
    Molina Healthcare (09/26/25)
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  • Manager Intake Specialists

    Hillside Family of Agencies (Rochester, NY)
    …communicated effectively to meet agency and regulatory requirements. + Facilitate Agency Utilization Management meetings to ensure residential youth continue to ... Collect, aggregate, and analyze data to identify unmet needs, utilization trends, and opportunities for improvement of existing services...that are aligned with those of the organization. + Management : Aligns the right work with the right people;… more
    Hillside Family of Agencies (09/16/25)
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  • Associate Director, Client Analytics

    Evolent (Albany, NY)
    …and internal leadership is preferred. + Familiarity with value-based care models and utilization management frameworks is preferred. To ensure a secure hiring ... claims, membership data, and clinical outcomes to uncover cost drivers, utilization trends, and opportunities for integrated care solutions using SAS, SQL,… more
    Evolent (09/12/25)
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  • Professional, Sub-Acute RN UM Reviewer - Medicare

    MVP Health Care (Tarrytown, NY)
    …of clinical nursing experience + At least 2 years of experience in utilization management of sub-acute Medicare reviews + Experience with Medicare guidelines ... every interaction **Your key responsibilities:** + Conduct timely and accurate utilization reviews for sub-acute Medicare cases. + Evaluate medical necessity, level… more
    MVP Health Care (09/30/25)
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  • Care Review Clinician, Prior Authorization

    Molina Healthcare (Albany, NY)
    …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... with PEGA helpful. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT… more
    Molina Healthcare (09/18/25)
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  • Care Review Clinician, PA (RN)

    Molina Healthcare (Rochester, NY)
    …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT… more
    Molina Healthcare (09/05/25)
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  • IT Desktop Support

    Corning Incorporated (Corning, NY)
    …Protection + Dameware remote connection/ utilization + Altiris Deployment server utilization + Asset management skills + Internet Explorer and various ... of standard IP telephony + Hardware ordering/deployment + Documentation (records) management + Knowledge base utilization + Project interaction +… more
    Corning Incorporated (09/16/25)
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  • Director, Clinical Systems

    Molina Healthcare (Yonkers, NY)
    …including design, development, implementation, and oversight of technology that drives core utilization management , care management , long-term services and ... management /leadership experience in a clinical leadership, clinical systems and/or informatics, utilization management , or care management role. *… more
    Molina Healthcare (10/01/25)
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  • Case Manager, RN (Commercial)

    Excellus BlueCross BlueShield (Rochester, NY)
    …of consistent and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health, Pharmacy, Registered Dietitian and ... within the group. + Responsible for all aspects of the Case Management department functions including quality, productivity, utilization performance, and… more
    Excellus BlueCross BlueShield (09/30/25)
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