• Case Manager, RN or Licensed Behavioral…

    Excellus BlueCross BlueShield (Dewitt, NY)
    …of consistent and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health , Pharmacy, Registered ... Managers, especially those with varied clinical expertise (ex. Social Work, Behavioral Health , Respiratory Therapy, Registered Dietitian, Registered Nurse,… more
    Excellus BlueCross BlueShield (09/30/25)
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  • Clinical Learning Facilitator - Utilization…

    Molina Healthcare (Buffalo, NY)
    …licensing mandate. + At least 2 years in case, disease or utilization management ; managed care; or medical/ behavioral health settings. + One year of ... Social Worker/Counseling License. + Certified Case Manager (CCM), Utilization Management Certification (CPHM), Certified Professional in Health Care Quality,… more
    Molina Healthcare (09/17/25)
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  • Healthcare Services Operations Support Auditor

    Molina Healthcare (Yonkers, NY)
    …program(s) proficiency. Preferred Qualifications * Utilization management , care management , behavioral health and/or long-term services and supports ... * At least 2 years health care experience, preferably in utilization management , care management , and/or managed care, or equivalent combination of… more
    Molina Healthcare (09/28/25)
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  • Nurse Educator

    CVS Health (NY)
    …in a managed care clinical operation environment ( utilization management , case management , and/or behavioral health case management ) required. + ... At CVS Health , we're building a world of health...support the training and compliance monitoring of the DSNP/MMP Management team. They are responsible for conducting audits of… more
    CVS Health (10/01/25)
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  • Utilization Case Manager- Inpatient Program

    Helio Health Inc. (Syracuse, NY)
    …mission to treat and promote recovery from the effects of substance use, mental health disorders, and other behavioral healthcare issues. To support the mission ... staff on current principles and standards of practice surrounding utilization and denials management . + Use effective...Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care,… more
    Helio Health Inc. (09/30/25)
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  • Behavioral Health Planning Analyst-…

    Evergreen Health (Buffalo, NY)
    …incidents in the CBH programs + Provides monthly reports to the behavioral health team to ensure caseload monitoring, risk management , and other tracking as ... working in a behavioral health setting required; clinical auditing, quality improvement, data analysis/reporting, and project management experience preferred more
    Evergreen Health (09/18/25)
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  • Behavioral Health Care Manager II

    Elevance Health (New Hyde Park, NY)
    ** Behavioral Health Care Manager II** A proud member of the Elevance Health family of companies, Carelon Behavioral Health , formerly Beacon Health ... an accommodation is granted as required by law. The ** Behavioral Health Care Manager II** is responsible...is licensed staff supervision. + Previous experience in case management / utilization management with a broad… more
    Elevance Health (09/30/25)
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  • Behavioral Health Medical…

    Elevance Health (New York, NY)
    ** Behavioral Health Medical Director-Psychiatrist Appeals** **Location:** This role enables associates to work virtually full-time, with the exception of ... Monday - Friday. Half day Saturday rotation, once a month.** The ** Behavioral Health Medical Director-Psychiatrist Appeals** is responsible for the… more
    Elevance Health (09/10/25)
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  • Medical Director, Behavioral Health…

    MVP Health Care (Rochester, NY)
    …and continuous improvement. To achieve this, we're looking for a **Medical Director, Behavioral Health Children's Services** , to join #TeamMVP. If you have ... reviews. Lead's MVP's efforts to collaborate in person and virtually with behavioral health network providers and facilities around clinical determinations,… more
    MVP Health Care (09/24/25)
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  • Social Worker - Inpatient Behavioral…

    Garnet Health (Harris, NY)
    …to make your career home with us as a Social Worker on our Inpatient Behavioral Health Unit (BHU) team at/in Garnet Health Medical Center-Catskill. ... is also responsible for obtaining insurance approval for inpatient behavioral health treatment, making sure that correct...utilization review, and insurance approval. Join the Garnet Health team and let your excellence shine. Salaries shown… more
    Garnet Health (08/26/25)
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