• Utilization Management Nurse

    Humana (Albany, NY)
    **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the… more
    Humana (11/16/25)
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  • Clinical Registered Nurse…

    Cognizant (Albany, NY)
    …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
    Cognizant (11/15/25)
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  • Utilization Management Nurse…

    CVS Health (Albany, NY)
    …with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management opportunity for RNs with a **New York** state licensure. ... Friday, 8:30am - 5pm EST. This role is a registered nurse that utilizes MCG rules and...unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of clinical experience… more
    CVS Health (10/24/25)
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  • Utilization Review Nurse

    Independent Health (Buffalo, NY)
    …Degree in Nursing required; Bachelor's degree preferred. Current, active, unrestricted, and licensed registered nurse ( RN ) required. + Two (2) years of ... Collaborative and Accountable. **Essential Accountabilities** Provide High Quality, Professional Utilization Management Services: (Medical necessity review for… more
    Independent Health (11/13/25)
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  • Utilization Review Nurse

    CDPHP (Latham, NY)
    …Minimum two (2) years of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization Management experience is ... you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for...recognized criteria and CDPHP policies, and procedures. QUALIFICATIONS: + Registered Nurse with a current New York… more
    CDPHP (09/23/25)
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  • Case Mgr, RN Casual- Case Management

    Northwell Health (Staten Island, NY)
    …Nursing, required. * Current license to practice as a Registered Professional Nurse in New York State. * Case Management Certification, preferred. * Minimum ... another level of care according to regulatory standards. * * Performs concurrent utilization management using Interqual criteria. * Conducts chart review for… more
    Northwell Health (11/21/25)
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  • RN Acute Case Manager - System Care…

    Guthrie (Binghamton, NY)
    …recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with ... degree in addition to a degree in Nursing. A registered nurse with five (5) years relevant...admissions and short procedures by translating clinical information to Utilization Management requirements using pre‐determined criteria. b.… more
    Guthrie (08/27/25)
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  • Director Pre Appeals Management -HSO…

    Mount Sinai Health System (New York, NY)
    …Active RN license in the state of employment required + Certification in Case Management (CCM, ACM) or Utilization Management preferred. + 7+ years of ... experience in clinical acute clinical, utilization management , appeals management or related operations + 3+ years in a leadership or management role +… more
    Mount Sinai Health System (11/01/25)
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  • RN for Case Management to cover…

    Trinity Health (Albany, NY)
    …is looking for an experienced RN to work as a Registered Professional Utilization Management Nurse (UMRN) per diem. The team is willing to help train ... **Employment Type:** Part time **Shift:** Day Shift **Description:** ** RN for Case Management to cover...selected candidate will** : + Be responsible for the utilization management , both concurrent and retroactive for… more
    Trinity Health (10/07/25)
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  • Case Manager, Registered Nurse…

    CVS Health (Albany, NY)
    …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital… more
    CVS Health (11/19/25)
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