• Utilization Review Clinician…

    Centene Corporation (New York, NY)
    …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... state of New York.** **Position Purpose:** Performs a clinical review and assesses care related to mental health and...Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members… more
    Centene Corporation (08/02/25)
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  • Utilization Review Nurse I

    Centene Corporation (New York, NY)
    …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review ... requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care… more
    Centene Corporation (08/02/25)
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  • Registered Nurse (RN) - Utilization

    Monroe County, NY (Rochester, NY)
    Full Jobs List Full Exams List Registered Nurse (RN) - Utilization Review Unit, Per Diem Location: Rochester, NY Title: Registered Nurse (RN) - Utilization ... Monroe Community Hospital Description of Duties This position is in the Utilization Review Unit and functions as an assessment nurse. This is a professional… more
    Monroe County, NY (08/02/25)
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  • RN Utilization Review - System Care…

    Guthrie (Binghamton, NY)
    …health care services regarding admissions, case management, discharge planning and utilization review . Responsibilites: Reviews admissions and service requests ... planning needs with healthcare team members. May prepare statistical analysis and utilization review reports as necessary. Oversees and coordinates compliance to… more
    Guthrie (07/05/25)
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  • Utilization Review Nurse

    CDPHP (Albany, NY)
    …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and ... is required as a Registered Nurse. + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims processing is preferred. +… more
    CDPHP (08/03/25)
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  • Utilization Review /Quality…

    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 ... completed in a timely manor for the Upstate/Syracuse City School District school-based mental health care program. This position helps ensure successful visits by DNV and OMH when they occur. Monitors and maintains performance improvement indicators on a… more
    SUNY Upstate Medical University (06/03/25)
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  • Registered Nurse (RN) - Utilization

    Rochester Regional Health (Rochester, NY)
    …able to work independently with minimum direction. + Act as a resource for utilization review stakeholders and assists team members in clinical problem solving. ... Job Title: Registered Nurse IDepartment: Utilization Management Location: Rochester General Hospital Hours Per...Week: 40 hours (Full-Time)Schedule: Monday - Friday, Days SUMMARY: Review all inpatient medical necessity denials for the health… more
    Rochester Regional Health (08/02/25)
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  • Utilization Case Manager

    Helio Health Inc. (Syracuse, NY)
    …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
    Helio Health Inc. (08/08/25)
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  • Asst Utilization Coordinator

    WMCHealth (Valhalla, NY)
    …implementation or investigation of the procedures specified in the Quality Management, Utilization Review and Discharge Planning Program at Westchester Medical ... agency, one of which must have been in the area of utilization review , quality assurance, risk management or discharge planning. About Us: Westchester Medical… more
    WMCHealth (08/02/25)
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  • Utilization Management RN

    Guidehouse (New York, NY)
    …based on physician certification + Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis + Performs ... None **What You Will Do** **:** + Performs chart review of identified patients to identify quality, timeliness and...policies and timelines + Adheres to CMS guidelines for utilization reviews as evidenced by utilization of… more
    Guidehouse (07/25/25)
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