• Care Review Clinician LPN / LVN

    Molina Healthcare (Buffalo, NY)
    …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
    Molina Healthcare (09/25/25)
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  • Care Review Clinician , Prior…

    Molina Healthcare (Albany, NY)
    …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of hospital or medical clinic… more
    Molina Healthcare (09/18/25)
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  • Care Review Clinician , PA (RN)

    Molina Healthcare (Rochester, NY)
    …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT LICENSURE… more
    Molina Healthcare (09/05/25)
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  • Care Review Clinician (RN)

    Molina Healthcare (Buffalo, NY)
    **JOB DESCRIPTION** **Job Summary** Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** * At least 2… more
    Molina Healthcare (10/02/25)
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  • Bilingual Integrated Clinician

    Catholic Charities Family Community Services (Rochester, NY)
    …periodic updates and a closing letter. + Provides information for HMO and payer utilization review as required. + Participates in staff meetings and clinical ... **BILINGUAL INTEGRATED CLINICIAN ** **Job Details** **Job Location** 79 North Clinton...and Community Services is growing and seeking an** **Bilingual Clinician ** **to join our family!** Catholic Charities Family and… more
    Catholic Charities Family Community Services (08/20/25)
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  • Social Worker - Emergency Department

    Garnet Health (Harris, NY)
    …Manager for the detox patient on the medical floor assuring discharge planning, utilization review , and insurance approval. At Garnet Health, we are committed ... organize/prioritize accordingly, and implement evidence based care. Social Work Clinician /Case Manager - primary role is to provide psychiatric/detox emergency… more
    Garnet Health (09/08/25)
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  • Sr. VP Medical Director

    Sedgwick (Albany, NY)
    …(10) of related experience required to include one (1) to three (3) years utilization review experience and three (3) years clinical quality control. **Skills & ... criteria; to provide leadership within the dedicated team of clinician and claim professionals in support of the dedicated...+ Knowledge of ADAA and FMLA + Knowledge of utilization review procedures + Knowledge of clinical… more
    Sedgwick (09/16/25)
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  • Clinical Counselor Outpatient Services

    Educational Alliance, Inc. (New York, NY)
    …appropriateness of the current level of treatment, corresponding with LOCADTR and utilization review instruments. + Coordinate integrated services with medical, ... providers. + Facilitation of individual and group-level interventions during other clinician vacations or leave + Ensure that clients' annual medical examinations… more
    Educational Alliance, Inc. (09/30/25)
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  • Program and Quality Manager Apheresis and Blood…

    Stony Brook University (Stony Brook, NY)
    …will be performed on the donor. * The incumbent participates in and conducts blood utilization review with the direction of the Blood Bank Medical Director. The ... Quality Coordinator. * The incumbent along with the nurse clinician , acts as a resource for all staff nurses,...or for a maximum of 90 days. An initial review of all applicants will occur two weeks from… more
    Stony Brook University (09/23/25)
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  • Psychologist 1/2

    New York State Civil Service (NY)
    …research psychology, industrial psychology, organizational psychology, health psychology, utilization review , guidance counseling, pastoral counseling, or ... the supervision of a licensed psychologist or other appropriate licensed clinician ; * Develop and write behavioral/treatment plans and complete functional… more
    New York State Civil Service (07/15/25)
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