• Utilization Management Specialist

    Mount Sinai Health System (New York, NY)
    **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing… more
    Mount Sinai Health System (01/02/26)
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  • 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, ... Job Summary: The UR-CR Specialist I is primarily responsible for ensuring that...reimbursement entities. This is achieved through a thorough chart review and utilization of first-level screening criteria… more
    SUNY Upstate Medical University (11/18/25)
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  • Senior Clinical Staff Specialist

    Rochester Institute of Technology (Rochester, NY)
    **9779BR** **Position Title:** Senior Clinical Staff Specialist **Organization:** Student Health Center **Job Responsibilities:** + Patient Care Services & Clinical ... delegated by the Administrative Supervisor: + Create Master Templates + Manage, review and adjust daily appointment schedules; use independent judgement to address… more
    Rochester Institute of Technology (11/01/25)
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  • Quality Management Specialist I

    DePaul (Rochester, NY)
    …follow-up consultation and training. + Responsible for Utilization Record Review functions to include Individual record audits, admission reviews, continued ... Overview The Quality Management Specialist works with the Quality Management Department to provide the highest achievable quality of services to the individuals we… more
    DePaul (01/09/26)
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  • Clinical Denials & Appeals Specialist

    Northwell Health (Melville, NY)
    …level of care decisions and billing status and ensures compliance with the Utilization Review standard and regulations. + Performs concurrent and retrospective ... reviews and formulates appeal letters to support appropriateness of admission and continued length of stay. + Ensures compliance...4+ years preferred. + Prior Acute Case Management and/or Utilization Review experience, preferred. + Must have… more
    Northwell Health (01/07/26)
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  • Clinical Documentation Improvement…

    Nuvance Health (Poughkeepsie, NY)
    …documentation is complete and accurate and reflects severity of illness and resource utilization . Participates in the education of all members of patient care team ... care are accurately reflected in the medical record. Accurately performs admission reviews for specific patient populations using clinical documentation guidelines.… more
    Nuvance Health (01/11/26)
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  • Clinical Denials & Appeals Specialist

    Northwell Health (Melville, NY)
    …level of care decisions and billing status and ensures compliance with the Utilization Review standard and regulations. Performs concurrent and retrospective ... conducts clinical reviews and formulates appeal letters to support appropriateness of admission and continued length of stay. Ensures compliance with current state,… more
    Northwell Health (01/06/26)
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  • Physician Advisor

    Mohawk Valley Health System (Utica, NY)
    … regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... appropriateness of admission and continued stay, severity, and morbidity/mortality. + Review patient status when admission criteria is non-sufficient for … more
    Mohawk Valley Health System (01/06/26)
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  • Academic Administrator II

    University of Rochester (Rochester, NY)
    …directly to the Senior Manager of Student Affairs, the Student Support Specialist plays a vital role in supporting students in workforce investment programs, ... through data collection, evaluation, and stakeholder engagement. The Student Support Specialist also oversees all mandatory student compliance items for new and… more
    University of Rochester (01/07/26)
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  • Specialty Registrar II

    University of Rochester (Rochester, NY)
    …**ESSENTIAL FUNCTIONS** **Registry Abstraction:** + Accurately identify all trauma admissions , transfers, and deaths, using clinical identifiers and strict ... registry vendor sponsored training workshops/meetings to maximize trauma registry utilization and performance. **Registry Admin Duties** + Oversee the conversion,… more
    University of Rochester (01/14/26)
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