• Professional, Sub-Acute RN UM Reviewer - Medicare

    MVP Health Care (Tarrytown, NY)
    …clinical nursing experience + At least 2 years of experience in utilization management of sub-acute Medicare reviews + Experience with Medicare guidelines ... RN licensure + Associate or bachelor's degree in nursing (BSN preferred) + Minimum 3 years of...interaction **Your key responsibilities:** + Conduct timely and accurate utilization reviews for sub-acute Medicare cases. + Evaluate medical… more
    MVP Health Care (09/30/25)
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  • Registered Nurse Case Manager (RN Case…

    Northwell Health (Staten Island, NY)
    …+ Facilitates patient management throughout hospitalization + Performs concurrent utilization management using evidence based medical necessity criteria + ... **Req Number** 167724 Registered Nurse Case Manager - FlexStaff Serves as liaison...Submits data to management regarding case management and/or quality initiatives… more
    Northwell Health (09/17/25)
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  • Registered Nurse Case Manager

    Northwell Health (Mount Kisco, NY)
    …+ Facilitates patient management throughout hospitalization. + Performs concurrent utilization management using evidence based medical necessity criteria. + ... Submits data to management regarding case management and/or quality initiatives....Job Qualification + Graduate from an accredited School of Nursing . Bachelor's Degree in Nursing , preferred. Must… more
    Northwell Health (10/04/25)
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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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  • Director of Care Coordination

    Crouse Hospital (Syracuse, NY)
    …a Registered Professional Nurse in New York State. + Recent acute care Utilization Management and Case Management experience. + Current certification in ... support systems. Coordinates financial and budgetary acquisitions, allocations and utilization of resources needed for quality, cost-effective, program(s)/service(s). +… more
    Crouse Hospital (09/18/25)
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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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  • Nurse Educator

    CVS Health (NY)
    …+ 3+ years of experience in a managed care clinical operation environment ( utilization management , case management , and/or behavioral health case ... lives in new markets across the country. + The Nurse Educator will support the training and compliance monitoring...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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  • Community Health Assessment Field Nurse

    Excellus BlueCross BlueShield (Rochester, NY)
    …assignments, difficult members and highly visible issues. + Understanding of the basic Utilization Management and Case Management aspects of the department ... and health care services for members. The SN CHA Nurse may also perform other technical and administrative tasks...and required. + Performs other functions as assigned by management . Minimum Qualifications: + RN with valid and current… more
    Excellus BlueCross BlueShield (09/27/25)
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  • Care Coordinator RN TRI PC Orchard Park

    Catholic Health (West Seneca, NY)
    …a registered nurse required + One (1) year previous case, disease, or utilization management experience preferred + One (1) year previous experience in a ... illness, improve compliance with evidence based clinical guidelines, encourage patient self- management , increase coordination of care, increase the utilization more
    Catholic Health (09/04/25)
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  • Care Manager

    Catholic Health Services (Smithtown, NY)
    …patients across the acute care continuum. + Performs required activities for utilization management , PRI assessment and completion, transition planning, and ... clinical medical/surgical or specialty experience required. + 2-3 years' Utilization Management , Performance Improvement, Transition Planning and/or Care… more
    Catholic Health Services (08/22/25)
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