• Care Coordination Manager (Registered Nurse)

    Crouse Hospital (Syracuse, NY)
    …day management of the RN Care Managers in the department, including Utilization Management , Discharge Planning and Denials and Appeals functions. + Assessing ... Manager who is responsible for providing day to day management of the RN Care Managers in the department....acute care discharge planning + Preferred - Acute care utilization review experience Benefits Overview: + Medical,… more
    Crouse Hospital (12/11/25)
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  • Appeals Manager

    BronxCare Health System (Bronx, NY)
    …assist the department's leadership develop strategies for denial prevention, improved utilization management , documentation of medical necessity and identify ... of stay, avoidable day and barriers to discharge processes pertaining to utilization management . - Liaisons and coordinates with other hospital departments… more
    BronxCare Health System (11/15/25)
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  • Health Insur & Auth Rep IV

    University of Rochester (Rochester, NY)
    …to discharge. Identifies problems, including but not limited to, pre-certifications, Utilization Management , Medicaid Pending, third party payer issues, and ... Communicates and follows-up with assigned area, Financial Assistance, Social Work, Utilization Management , Financial Case Management , patients, families,… more
    University of Rochester (12/20/25)
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  • Medical Director-Payment Integrity

    Humana (Albany, NY)
    …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, ...with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (12/11/25)
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  • Case Manager - AOMC

    Arnot Health (Elmira, NY)
    …related to the management of patient care . The Case Manager will review all patients for utilization management and appropriate discharge planning. The ... the guidelines. . Identifies the appropriate patients for Case Management services. . Maintains a working knowledge of the...The Case Manager tracks and trends LOS , resource utilization , outliers, readmissions , denials , delay days… more
    Arnot Health (11/06/25)
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  • Medical Director - Pharmacy Appeals

    Humana (Albany, NY)
    …management + Utilization management experience in a medical management review organization such as Medicare Advantage, managed Medicaid, or Commercial ... The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The...with prior experience participating in teams focusing on quality management , utilization management , or similar… more
    Humana (12/03/25)
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  • RN Case Manager

    Calvary Hospital (Bronx, NY)
    …and identify the expected length of stay (ELOS). The RNCM participates in the Utilization Review , Discharge Planning, Risk Management , and Quality Assessment ... Qualifications: + Five (5) or more years experience in either Utilization Management , Quality Assessment and Improvement, Risk Management , and/or Discharge… more
    Calvary Hospital (12/10/25)
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  • Care Manager - Readmission Specialist

    Stony Brook University (Stony Brook, NY)
    …telephonically post-discharge and assist with barriers to care * Prior experience with Care Management or Utilization Management * Understand levels of care ... is provided to the patients. * Documents the case management plans such as clinical needs, barriers, utilization...or for a maximum of 90 days. An initial review of all applicants will occur two weeks from… more
    Stony Brook University (12/20/25)
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  • Associate Chief Medical Officer

    Catholic Health Services (West Islip, NY)
    …CH HAC Meeting, Hospital Performance Improvement and Patient Safety Committee, and Utilization Management Committee. + Participate in the development and ... in and serve as a physician resource for Risk Management activities and processes, such as Root Cause Analyses,...activities and processes, such as Root Cause Analyses, to review and monitor the quality of care provided to… more
    Catholic Health Services (11/25/25)
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  • Case Manager - RN

    Calvary Hospital (Bronx, NY)
    …Flex Spending, Transit Check. + Free On-Site Parking Requirements Participates in the Utilization Review , Discharge Planning, Risk Management , and Quality ... NYS licensure. + Five (5) or more years experience in either Utilization Management , Quality Assessment and Improvement, Risk Management , and/or Discharge… more
    Calvary Hospital (01/03/26)
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