• 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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  • Medical Director - Nat'l IP UM Team

    Humana (Albany, NY)
    …providers. + Utilization management experience in a medical management review organization, such as Medicare Advantage, Managed Medicaid, or Commercial ... + Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices **Work Schedule Monday - Friday w/standard… more
    Humana (11/15/25)
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  • Sr Manager Clinical UM Operations

    Healthfirst (NY)
    …oversight and operational management for all utilization management functions, including prior authorization, concurrent review , and service requests ... efforts for audits, performance improvement plans, and corrective actions related to utilization management + Foster a culture of accountability, professional… more
    Healthfirst (11/27/25)
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  • Clinical Care Coordinator

    Kaleida Health (Williamsville, NY)
    …plans/care paths are addressed and met. Serve as liaison to ancillary and utilization review services, serve as communication link between health team members. ... planning, case management and home care required. Knowledge of Utilization Management . Use of computer applications related to health care industry as well… more
    Kaleida Health (12/31/25)
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  • Care Manager - Registered Nurse

    Crouse Hospital (Syracuse, NY)
    …of hospital resources while maintaining the quality of care. + Participates in the utilization management process using standards of care to determine the most ... Coordination Services team is hiring a Care Manager to review the services delivered to patients and compare it...- Five (5) years acute hospital experience. + Case Management or Utilization Management experience… more
    Crouse Hospital (12/31/25)
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  • Integrated Outpatient Senior Clinician

    FLACRA (Penn Yan, NY)
    …progress notes and other documentation required for the client medical record and utilization management within the timelines outlined by FLACRA. + Participates ... + Monitors, support, and mentors clinicians in their practice management to meet expectations for excellent client care. +...in quality initiatives and utilization review activities as requested. + Strives… more
    FLACRA (12/11/25)
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  • Payment Integrity Clinician

    Highmark Health (Albany, NY)
    …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
    Highmark Health (11/14/25)
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  • Lead Clinical and Population Health Analyst…

    Highmark Health (Albany, NY)
    …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... both internally developed and vendor-sourced criteria. This includes proactive monitoring, review , and timely updates in response to new evidence, regulatory… more
    Highmark Health (12/31/25)
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  • UM Administration Coordinator

    Humana (Albany, NY)
    …health first** The UM Administration Coordinator 2 contributes to administration of utilization management . The UM Administration Coordinator 2 performs varied ... member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care… more
    Humana (01/01/26)
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