- Catholic Health Services (Melville, NY)
- … system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the ... Overview Catholic Health is one of Long Island's finest ...was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews… more
- CenterWell (Albany, NY)
- …Previous Medicare Advantage/Medicare + Current nursing experience in Hospital, SNF, LTAC, DME or Home Health . + Bilingual **Use your skills to make an impact** ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy… more
- Monroe Plan for Medical Care (Rochester, NY)
- Utilization Management Intake Representative II Summary Title: Utilization Management Intake Representative II ID:UM 42 (ROC) Location:Rochester, Buffalo, ... Syracuse, or Utica Job Type:Full-time Date Posted:07/24/2025 Openings:1 Department: Utilization Management Description Looking for meaningful work with an… more
- University of Rochester (Rochester, NY)
- …work is remote with some on-site requirements as needed. Qualifications: RN with Utilization Review experience preferred; 3-5 years of recent acute hospital ... Utilization Management (UM) RN position spans the entire health care system working collaboratively with Health ...insurance companies. The UM RN is responsible for the review of clinical documentation utilizing evidence based criteria to… more
- CenterWell (Albany, NY)
- …Experience a plus + Current nursing experience in Hospital, SNF, LTAC, DME or Home Health . + Bilingual We offer tangible and intangible benefits such as ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy… more
- CenterWell (Hauppauge, NY)
- …care patient services provided by clinical personnel. This role is a focused on both home health clinical quality assurance and home health clinical ... related to the case, including disciplines required, to determine home health or hospice needs. Accountable to...clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the… more
- Agiliti Health (NY)
- **POSITION SUMMARY** Create and deliver high-impact, customer-facing business- review presentations that clearly communicate Agiliti's value, service performance, and ... contract utilization trends. This role blends visual storytelling expertise with...AND RESPONSIBILITIES** + Design and produce facility- and division-level business- review decks that highlight service performance, spend trends, and… more
- Evolent (Albany, NY)
- …call center staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What ... **Your Future Evolves Here** Evolent Health has a bold mission to change the...Therapy you will be a key member of the utilization management team. We can offer you a meaningful… more
- The New Jewish Home (Bronx, NY)
- The New Jewish Home has a long experience delivering rehabilitation and home care services. Our goal is to help each patient get well, stay well and return to ... health and independence as quickly as possible. The HAPI Division of The New Jewish Home is seeking for a full time Director of Patient Care to join our team. Job… more
- Guthrie (Corning, NY)
- …and autonomy in nursing practice. Preferred experience with PCMH process, care management/ utilization review , and payer knowledge. Fast paced ambulatory care ... as a practice support in the Patient Centered Medical Home development and process. The position is an integral...remote monitoring capabilities, to engage patients and monitor chronic health conditions. + c. Measures improvements in process and… more