• Psychologist 1/2

    New York State Civil Service (Wassaic, NY)
    …research psychology, industrial psychology, organizational psychology, health psychology, utilization review , guidance counseling, pastoral counseling, or ... to:* Implement and monitor behavior support plans and functional behavioral assessments for individuals with challenging behaviors associated with Intellectual… more
    New York State Civil Service (11/18/25)
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  • Disease Management Nurse - Remote

    Sharecare (Albany, NY)
    …change techniques, the nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
    Sharecare (10/22/25)
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  • Pharmacist - Case and Disease Management…

    Highmark Health (Albany, NY)
    …residency program + 5 - 7 years in Pharmacy + 3 - 5 years in Pharmacist - Utilization Management + 3 - 5 years in Pharmacist - Medical Therapy Management ... to medication therapy are transitioned to a Pharmacist for Case & Disease Management (CMDM). The incumbent then conducts thorough research to evaluate the patient… more
    Highmark Health (11/15/25)
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  • Transplant Care Nurse (Remote)

    Highmark Health (Albany, NY)
    …triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, ... Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or… more
    Highmark Health (11/06/25)
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  • Senior Decision Support Consultant

    Highmark Health (Albany, NY)
    …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... executing all facets of the Informatics project management process, leading multiple project managers, and potentially guiding,...in the resolution of issues or problems. + Access, review , utilize, contribute content to and participate in the… more
    Highmark Health (11/14/25)
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  • Social Worker II

    Ellis Medicine (Schenectady, NY)
    …plan, implement and evaluate individual healthcare needs. Integrate Discharge Planning, Utilization Review and Performance Improvement activities at the patient, ... levels. Efficiently and effectively anticipates, identifies and resolves issues through utilization review and discharge planning processes. Collaborates with… more
    Ellis Medicine (09/23/25)
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  • PCO Medical Director- UM - Full Time

    CenterWell (Albany, NY)
    …of Physician Strategy at Utilization Management . The Medical Director conducts Utilization review of the care received by members in an assigned region, ... practice management . + Utilizationmanagement experience in a medical management review organization, such as Medicare Advantage,managedMedicaid, or… more
    CenterWell (11/06/25)
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  • Medical Director Aetna Duals Center of Excellence

    CVS Health (Albany, NY)
    …to cover urgent cases can be done from your laptop. **Fundamental Components:** * Utilization management - The medical director will perform concurrent and prior ... Multiple state licensure a plus. **Preferred Qualifications:** Previous Experience in Utilization Management / Claims Determination with another Health Plan… more
    CVS Health (11/13/25)
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  • AVP of OR/Peri-Op Services

    Albany Medical Center (Albany, NY)
    …short- and long-term goals and objectives. As a member of the nursing executive management team, the AVP participates in the efficient and effective management ... in nursing, involving perioperative and/or procedural services + Demonstrated progressive management experience, minimum 3-5 years Skills, Knowledge & Abilities: +… more
    Albany Medical Center (09/27/25)
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  • Senior Intake Coordinator

    Highmark Health (Buffalo, NY)
    …Description :** **JOB SUMMARY** This job captures all inbound phone inquires for utilization management review from providers and pharmacies. The incumbent ... a prior authorization case in Highmark's Utilization Management system for Prior Authorization clinical review ,...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
    Highmark Health (11/18/25)
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