• Care Review Clinician ( RN )

    Molina Healthcare (Rochester, NY)
    For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
    Molina Healthcare (11/01/25)
    - Related Jobs

  • Respiratory Registered Nurse

    Glengariff Rehabilitation and Healthcare Center (Glen Cove, NY)
    …days a week 37.5 - 40 hours per week Respiratory Therapist (RT) / Respiratory Nurse ( RN ) We are searching for a highly motivated, flexible, organized, skilled ... meaningful contributions to the rehab team conferences, patient care conferences, utilization review meetings, family conferences, and caregiver training sessions. +… more
    Glengariff Rehabilitation and Healthcare Center (10/22/25)
    - Related Jobs

  • RN Care Review Clinician Remote

    Molina Healthcare (Rochester, NY)
    …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The Care Review Clinician ( RN ) provides support for clinical member services review...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required… more
    Molina Healthcare (11/21/25)
    - Related Jobs

  • 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 ... avoidable day and barriers to discharge processes pertaining to utilization management . - Liaisons and coordinates with...department physician advisors and clinical staff. Qualifications - NYS Registered Nurse required - The Appeal Manager… more
    BronxCare Health System (11/15/25)
    - Related Jobs

  • Admissions Registered Nurse

    Northwell Health (Glen Cove, NY)
    …patient transfer to inpatient bed and ensures hand off communication to accepting nurse . + Promotes optimum utilization of hospital beds by conducting rounds ... required. Bachelors of Nursing, required. + Current License to practice as a Registered Professional Nurse in New York State required, plus specialized… more
    Northwell Health (11/14/25)
    - Related Jobs

  • Care Review Clinician ( RN )

    Molina Healthcare (Syracuse, NY)
    …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… more
    Molina Healthcare (11/21/25)
    - Related Jobs

  • Commercial Review Specialist I

    SUNY Upstate Medical University (Syracuse, NY)
    …including PC, Windows, Microsoft applications, Zoom/WebEx platforms, etc. Preferred Qualifications: Utilization management or utilization review experience, ... preparing regulatory notices for delivery to the patient Minimum Qualifications: NYS Licensed/ Registered (or eligible) RN , Bachelor's Degree in Nursing, and a… more
    SUNY Upstate Medical University (11/18/25)
    - Related Jobs

  • Case Manager, Medicaid Long Term Support Program

    MVP Health Care (Tarrytown, NY)
    …you'll bring:** + Current New York State Licensure as a Registered Nurse required. + Certification in Case Management required within 24 months after ... **Your key responsibilities:** + Utilize the essentials of an integrated utilization management and case management model that includes assessment, planning,… more
    MVP Health Care (11/21/25)
    - Related Jobs

  • Case Manager - AOMC

    Arnot Health (Elmira, NY)
    … registered nursing program with a current license as a registered nurse . BSN or Case Management Certification preferred. EXPERIENCE: Three to five years ... patient care . The Case Manager will review all patients for utilization management and appropriate discharge planning. The Case Manager's average caseload will… more
    Arnot Health (11/06/25)
    - Related Jobs

  • RN OB Case Manager

    Highland Hospital (Rochester, NY)
    … RN Care Manager's central role integrates and coordinates access and utilization management , proactive patient management , care facilitation and ... **17006BR** **Title:** RN OB Case Manager **Department/Cost Center:** 628 -...nursing experience preferred. Progressive clinical experience; community health, care management , and/or disease management is preferred. Experience… more
    Highland Hospital (09/16/25)
    - Related Jobs