• Utilization Management Nurse

    CVS Health (Albany, NY)
    …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST zones.… more
    CVS Health (08/16/25)
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  • Utilization Management Nurse

    CenterWell (Albany, NY)
    …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
    CenterWell (08/08/25)
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  • Utilization Management Nurse

    CenterWell (Albany, NY)
    …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
    CenterWell (08/02/25)
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  • Clinical UM Nurse 2

    CenterWell (Albany, NY)
    **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... high-volume community or mail order pharmacy practice environment + Previous experience in utilization management + Education: BSN or Bachelor's degree in a… more
    CenterWell (08/01/25)
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  • Insurance Specialist - Samaritan Hospital - PD…

    Trinity Health (Troy, NY)
    …requirements for Utilization Management and works collaboratively with Utilization Management /Concurrent Review Nurse , physicians, staff and other ... identification of possible concurrent denials, forwards information to the appropriate Utilization Management /Concurrent Review Nurse within identified… more
    Trinity Health (07/26/25)
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  • Utilization Review Nurse

    CDPHP (Albany, NY)
    …required as a Registered Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims processing is ... you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for...transportation, DME requests and inpatient readmissions. In collaboration with management , the UR nurse identifies potentially high-cost… more
    CDPHP (08/03/25)
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  • Utilization Review Nurse I

    Centene Corporation (New York, NY)
    …and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a ... benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for… more
    Centene Corporation (08/02/25)
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  • Asst Utilization Coordinator

    WMCHealth (Valhalla, NY)
    …the implementation or investigation of the procedures specified in the Quality Management , Utilization Review and Discharge Planning Program at Westchester ... York State Department of Education, as a registered professional nurse . Training and Experience: three years of experience where...of which must have been in the area of utilization review, quality assurance, risk management or… more
    WMCHealth (08/02/25)
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  • Insurance Specialist-Mount Sinai West-…

    Mount Sinai Health System (New York, NY)
    …Excel and Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...EOW** To maintain front end operations of the Case Management Department by monitoring all incoming correspondence and ensuring… more
    Mount Sinai Health System (07/23/25)
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  • Registered Nurse -Quality Management

    Veterans Affairs, Veterans Health Administration (Bronx, NY)
    …Responsibilities The James J. Peters VA Medical Center is recruiting for 1 Quality Management Registered Nurse for the Renal Transplant Program. At the full ... but are not limited to the following: The Quality Management (QM) Registered Nurse (RN) demonstrates leadership,...clinical expertise to improve quality of care and resource utilization at the expert level with improved outcomes beyond… more
    Veterans Affairs, Veterans Health Administration (08/19/25)
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