• PA Office Support Representative

    Highmark Health (Buffalo, NY)
    …the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Committee (URAC), Pennsylvania Department of Health , Department ... Inc. **Job Description :** I. GENERAL OVERVIEW: * Receive, review and make determinations regarding physician reviewer assignments for...able to function interact with all members of the health care team, both internal and external. * This… more
    Highmark Health (11/18/25)
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  • Case Manager, Registered Nurse - Fully Remote

    CVS Health (Albany, NY)
    …experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health /Substance Abuse or Maternity/ Obstetrics experience. ... At CVS Health , we're building a world of health ...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized… more
    CVS Health (11/19/25)
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  • Psychologist 1/2

    New York State Civil Service (NY)
    …in experimental psychology, research psychology, industrial psychology, organizational psychology, health psychology, utilization review , guidance ... With Developmental Disabilities, Office for Title Psychologist 1/2 Occupational Category Health Care, Human/Social Services Salary Grade 21 Bargaining Unit PS&T -… more
    New York State Civil Service (10/16/25)
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  • Case Manager RN - Per Diem

    Nuvance Health (Carmel, NY)
    …essential services a community needs from their local hospital, including Emergency and Behavioral Health Services. Our accolades include: * The Leapfrog Group - ... *Description* *Intro:* At Nuvance Health , we enjoy the benefits of a two-state...Program (MBSAQIP) * Robotic Center of Excellence - Surgical Review Corporation (SRC) At Putnam Hospital, our team members… more
    Nuvance Health (11/18/25)
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  • Mental Health Clinical Director

    Monte Nido (White Plains, NY)
    …Qualifications: + At least 5 years of leadership experience in a behavioral health setting is preferred; may substitute leadership experience elsewhere. ... + Working knowledge of admissions and intake, Utilization Review , and 3rd party or insurance...Experience in an Eating Disorder program or other residential behavioral health setting is very helpful. +… more
    Monte Nido (10/30/25)
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  • Dental Network Service Representative

    Highmark Health (Albany, NY)
    …designs, competitive position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist ... confidentiality agreements. Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees.… more
    Highmark Health (11/14/25)
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  • Pharmacy Product Director - Medicare DSNP

    Highmark Health (Albany, NY)
    …+ Participate in product specific Pharmacy and Therapeutics Committees and Drug Utilization Review (DUR) Committees as necessary or contractually required. + ... position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of...with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as… more
    Highmark Health (11/14/25)
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  • Healthcare Services Auditor (RN) (New York)

    Molina Healthcare (Bronx, NY)
    …* Performs audits in utilization management, care management, member assessment, behavioral health , and/or other clinical teams, and monitors clinical staff ... * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Utilization management, care management, behavioral health … more
    Molina Healthcare (11/21/25)
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  • Licensed Psychologist

    New York State Civil Service (Albany, NY)
    …our system through innovation and change, and will serve as OPWDDs first utilization review team. The BSARR Licensed Psychologist (Clinical Quality Team Lead) ... the state.. Conducting comprehensive case reviews of medical, psychiatric, behavioral health records and psychological assessments, functional assessments,… more
    New York State Civil Service (11/08/25)
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  • Registered Nurse (RN) Care Manager

    Whitney Young Health Center (Albany, NY)
    …detection. The Care Manager (RN) will assist in coordination and integration of medical and behavioral health by working with the patient as well as various WYH ... Be a part of the mission at Whitney Young Health (WYH) to provide high quality healthcare that is...focusing care coordination attention on the at-risk population driving utilization and costs to improve efficiency, quality and patient… more
    Whitney Young Health Center (11/15/25)
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