• Senior Intake Coordinator

    Highmark Health (Buffalo, NY)
    …research to fulfill the call, such as verifying benefit coverage, creation of a prior authorization case in Highmark's Utilization Management system for Prior ... IS ON-SITE ONLY This job captures all inbound phone inquires for utilization management review from providers and pharmacies. The incumbent assesses the verbal… more
    Highmark Health (05/08/25)
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  • Utilization Review Nurse

    CDPHP (Albany, NY)
    …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services ... requiring prior authorization. This includes approval determinations and appropriate exceptions,...a Registered Nurse. + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims… more
    CDPHP (05/09/25)
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  • Utilization Management Services Rep…

    Excellus BlueCross BlueShield (Rochester, NY)
    …you to apply! Job Description: Summary: This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. ... end-to-end process. + Demonstrates proficiency in basic navigation and utilization of department specific applications. + Demonstrates role-specific competencies as… more
    Excellus BlueCross BlueShield (04/27/25)
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  • Care Review Clinician, Inpatient Review (RN)

    Molina Healthcare (Rochester, NY)
    …Nursing **Preferred Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge ... 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 (05/09/25)
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  • Utilization Review/Quality Assurance…

    SUNY Upstate Medical University (Syracuse, NY)
    Job Summary: The Utilization Review/Quality Assurance Coordinator is responsible for all compliance related paperwork and ensures all compliance paperwork is ... an applicant for employment provide his or her current compensation, or any prior compensation history, until such time as the applicant is extended a conditional… more
    SUNY Upstate Medical University (03/04/25)
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  • Telephonic UM Administration Coordinator

    Humana (Albany, NY)
    …with medical terminology and/or ICD-10 codes. + Member service + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... organization. **Additional Information** **Work Schedule:** + Monday-Friday 8am-5pm EST, and work 1 weekend a quarter. Schedule subject to change based on business needs. As part of our hiring process, we will be using an exciting interviewing technology… more
    Humana (05/11/25)
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  • Account Executive - Healthcare

    Custom Computer Specialists (Hauppauge, NY)
    …the ability to work in the spotlight and be held accountable for results. . Prior utilization and considerable experience with contact database (CRM tool) and MS ... Office suite of products including Word, PowerPoint, and Excel. . Excellent presentation and demonstration skills to executives and individual contributors either in a group setting, one on one or over the phone. . Ability to comprehend and then articulate… more
    Custom Computer Specialists (05/06/25)
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  • Partner, US Field Access & Reimbursement - Retina

    Astellas Pharma (Albany, NY)
    …access and reimbursement topics with expertise in payer coverage, buy-and-bill, and Utilization Management criteria (ie Prior Authorization, Step Edits, other ... forms of precertification). This individual will also play a critical role in educating customers on company programs that support patient access and provider reimbursement. The role requires establishing and maintaining collaborative relationships with… more
    Astellas Pharma (05/10/25)
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  • 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 (05/03/25)
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  • RN Clinical Review Nurse - Prior…

    Centene Corporation (New York, NY)
    …must possess NY RN State Licensure **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and appropriate ... 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 (05/03/25)
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