• 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 ... member's - ages 0-18.** **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 (11/08/25)
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  • RN Care Review Clinician Remote

    Molina Healthcare (Albany, NY)
    JOB DESCRIPTION **Job Summary** The Care Review Clinician RN provides support for clinical member services review assessment processes. Responsible for ... Candidates with MCO experience are highly preferred. The Care Review Clinician must be able to work...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** *… more
    Molina Healthcare (11/26/25)
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  • Care Review Clinician (RN)

    Molina Healthcare (Rochester, NY)
    …care unit (ICU) or emergency room. Previous experience in managed care 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 (11/27/25)
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  • Care Review Clinician (LVN/ LPN)

    Molina Healthcare (Albany, NY)
    …in a medical unit or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary… more
    Molina Healthcare (11/12/25)
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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 (10/26/25)
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  • Care Review Clinician (RN)

    Molina Healthcare (Buffalo, NY)
    …on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member ... services review assessment processes. Responsible for verifying that services are...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
    Molina Healthcare (11/23/25)
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  • Care Review Clinician (RN)

    Molina Healthcare (Syracuse, NY)
    JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… more
    Molina Healthcare (11/21/25)
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  • Integrated Outpatient Senior Clinician

    FLACRA (Penn Yan, NY)
    …within the timelines outlined by FLACRA. + Participates in quality initiatives and utilization review activities as requested. + Strives to understand and meet ... Integrated Outpatient Senior Clinician FLACRA Penn Yan, NY (Onsite) Full-Time $34.00/Hour...plus. Valid NYS driver's License. Job Summary:The integrated senior clinician is a clinician with demonstrated leadership… more
    FLACRA (11/11/25)
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  • Payment Integrity Clinician

    Highmark Health (Albany, NY)
    …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
    Highmark Health (11/14/25)
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  • Medical Management Clinician Associate

    Elevance Health (Latham, NY)
    …or equivalent. + Requires a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN or ... The **Medical Management Clinician Associate** is responsible for ensuring appropriate, consistent administration of plan benefits by reviewing clinical information… more
    Elevance Health (11/21/25)
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