• Utilization and Appeals Manager

    Catholic Health Services (Melville, NY)
    …queries from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, ... to remain current with industry standards and business objectives related to Utilization and Care Management as appropriate. Sound knowledge and skill… more
    Catholic Health Services (07/24/25)
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  • RN Clinical Manager Home Health

    CenterWell (Hauppauge, NY)
    …license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home health ... sit on-site at our Hauppauge, NY branch location.** The ** RN Clinical Manager** coordinates and oversees all direct care...(NY state requirement) + Current state license as a Registered Nurse . + Proof of current CPR.… more
    CenterWell (08/08/25)
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  • RN - HIV Medicine Practice

    Albany Medical Center (Albany, NY)
    …States of America) Salary Range: $60,028.00 - $99,023.00 Salary range: $33/hr. - $47.60/hr. Registered Nurse ( RN ) - Full TimeHIV Medicine Clinic - Albany, ... advanced practice provider (APP) and the supervision of the Nurse Manager ( RN ) and/or Nurse ...Nursing program is required* Current NYS license as a Registered Nurse is required* Minimum of 1-2… more
    Albany Medical Center (07/23/25)
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  • Director of Nursing Professional Practice,…

    Mount Sinai Health System (New York, NY)
    …the Daily Management Board process/practice improvement activities to facilitate the utilization of evidence and data related to Nurse Sensitive Indicators ... **Licensing and Certification Requirements (if applicable)** + Licensed as a registered nurse , Issuing Agency: Department of Health/Office of Professions… more
    Mount Sinai Health System (07/15/25)
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  • Clinical Appeals Nurse ( RN )

    Molina Healthcare (Yonkers, NY)
    **JOB DESCRIPTION** For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state they reside This position will support ... within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of previously denied cases… more
    Molina Healthcare (08/02/25)
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  • Care Coordinator RN SJC Mercy Comprehensive…

    Catholic Health (Buffalo, NY)
    …Degree in Nursing required + Current, unrestricted licensure by New York State as a Registered Nurse ( RN ) required EXPERIENCE + Minimum of (1) year ... compliance with evidence based clinical guidelines, encourage patient self- management , increase coordination of care, increase the utilization...experience as a registered nurse required + One year previous… more
    Catholic Health (07/23/25)
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  • RN Manager Capacity Management

    Trinity Health (Syracuse, NY)
    …care. + Graduate of an accredited School of Nursing and current licensure as a Registered Nurse in New York State. + Specialty credentialing & educational degree ... throughput opportunities. The Throughput Manager of Patient Logistics Department is registered professional nurse that is accountable for applying positive… more
    Trinity Health (08/08/25)
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  • RN Care Coordinator PCMH (Patient Centered…

    Guthrie (Corning, NY)
    …data analysis and process outcome evaluation. Education, License & Cert: Licensed Registered Nurse . Bachelor's Degree in Nursing or related field required. ... applicant must have a current license as a Professional Registered Nurse in their state of practice...in nursing practice. Preferred experience with PCMH process, care management / utilization review, and payer knowledge. Fast paced… more
    Guthrie (07/25/25)
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  • Care Review Clinician, PA ( RN )

    Molina Healthcare (Buffalo, NY)
    …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual… more
    Molina Healthcare (08/08/25)
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  • RN - MDS Nurse Assessor

    Elderwood (Lake Placid, NY)
    …with experience!) NEW:Gas Allowance Benefit for Full-time and Part-time positions Are you a Registered Nurse ( RN ) with Medicare experience? Do you consider ... Salary $74,000 to $96,525 / year Overview RN - MDS Nurse Assessor Pay...Federal, State, and facility policies + Actively participate in utilization management processes, including PDPM and state… more
    Elderwood (07/08/25)
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