• Care Review Clinician, Inpatient Review (RN)

    Molina Healthcare (Albany, NY)
    …standing. **Preferred Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and ... financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes requests… more
    Molina Healthcare (06/20/25)
    - Related Jobs
  • Care Review Clinician, PA (RN) Transplants

    Molina Healthcare (Yonkers, NY)
    …holidays.** Preferred Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare… more
    Molina Healthcare (07/17/25)
    - Related Jobs
  • Medical Director - Commercial Appeals

    CVS Health (Albany, NY)
    …in Health Care Delivery System eg, Clinical Practice and Health Care Industry. * Prior UM ( Utilization Management) experience *Active and current state medical ... license without encumbrances *M.D. or DO, Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience. **Preferred Qualifications** Active and current state medical license in CA without encumbrances and… more
    CVS Health (07/04/25)
    - Related Jobs
  • Clinical Review Nurse - Prior Authorization

    Centene Corporation (New York, NY)
    …a fresh perspective on workplace flexibility. **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and ... teams, to assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of… more
    Centene Corporation (07/25/25)
    - Related Jobs
  • Mgr Health Insurance & Prior Authorization…

    University of Rochester (Rochester, NY)
    …services and to ensure that the appropriate referrals are received prior to service. **ESSENTIAL FUNCTIONS** **_Personnel Management_** + Oversee the supervisors ... Enrollment & Outreach, Financial Assistance, Registration and Insurance Management, Utilization Management, Social Work, Patient Accounts, Medical Records, Home Care… more
    University of Rochester (07/02/25)
    - Related Jobs
  • Care Manager ( Registered Nurse / RN )

    Catholic Health Services (Port Jefferson, NY)
    …for Care Management 3+ Years acute care clinical RN experience required Prior RN experience in Utilization Management, Performance Improvement, Transition ... across the acute care continuum. Perform required activities for utilization management, PRI assessment and completion, transition planning, and identification… more
    Catholic Health Services (06/30/25)
    - Related Jobs
  • Supervisor, Care Review (RN)

    Molina Healthcare (Syracuse, NY)
    …an integrated Care Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards.… more
    Molina Healthcare (07/27/25)
    - Related Jobs
  • Sr. Manager, Executive Protection

    Pfizer (New York, NY)
    …+ Proficient report writer. + Prior experience in budget management. + Prior exposure to and utilization of intelligence analysis. + Good computer skills. ... + Excellent communication skills with emphasis on security presentations/briefings for Executives and Staff. + Excellent people skills - ability to coordinate and collaborate with executive leaders, leadership's staff, security professionals and business… more
    Pfizer (07/23/25)
    - Related Jobs
  • Medical Director, Commercial Line of Business

    Excellus BlueCross BlueShield (Rochester, NY)
    …Services area including, but not limited to, Medical and Pharmacy Utilization Management, quality management, member care management, and medical policy processes, ... Level I + Reviews and makes recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include:… more
    Excellus BlueCross BlueShield (07/01/25)
    - Related Jobs
  • Field Medical Director, Interventional Cardiology…

    Evolent (Albany, NY)
    …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a ... meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your… more
    Evolent (04/30/25)
    - Related Jobs