• 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 ... Upon identification of possible concurrent denials, forwards information to the appropriate Utilization Management /Concurrent Review Nurse within… more
    Trinity Health (07/26/25)
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  • Utilization Review Nurse

    CDPHP (Albany, NY)
    …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must… more
    CDPHP (08/03/25)
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  • Utilization Review Nurse I

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

    Rochester Regional Health (Rochester, NY)
    …class as needed. Responsibilities include concurrent (as needed) and retrospective reviews. The Utilization Management Nurse will act as a resource on ... Job Title: Registered Nurse IDepartment: Utilization Management ...with minimum direction. + Act as a resource for utilization review stakeholders and assists team members… more
    Rochester Regional Health (08/02/25)
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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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  • Utilization Management RN

    Guidehouse (New York, NY)
    …based on physician certification + Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis + Performs ... **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:** None **Clearance Required** **:**...License - REQUIRED + 4+ years of experience in utilization management + Familiarity with MCG and… more
    Guidehouse (07/25/25)
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  • Utilization Management

    Elevance Health (Latham, NY)
    ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible...and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible… more
    Elevance Health (08/08/25)
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  • Asst Utilization Coordinator

    WMCHealth (Valhalla, NY)
    …in the implementation or investigation of the procedures specified in the Quality Management , Utilization Review and Discharge Planning Program at ... 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 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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