• Utilization Review Nurse I

    Centene Corporation (New York, NY)
    …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical ... requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care… more
    Centene Corporation (08/02/25)
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  • Utilization Review Nurse

    CDPHP (Albany, NY)
    …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must… more
    CDPHP (08/03/25)
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  • Registered Nurse (RN) - Utilization

    Monroe County, NY (Rochester, NY)
    Full Jobs List Full Exams List Registered Nurse (RN) - Utilization Review Unit, Per Diem Location: Rochester, NY Title: Registered Nurse (RN) - ... Agency/Dept.: Monroe Community Hospital Description of Duties This position is in the Utilization Review Unit and functions as an assessment nurse . This is a… more
    Monroe County, NY (08/02/25)
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  • Registered Nurse - Utilization

    Trinity Health (Syracuse, NY)
    …Day shifts. Emergency department experience preferred. **Position Purpose:** The Registered Nurse Utilization Review (UR), Clinical Care Manger ... (CCM) actively manages the utilization review process and patient progression from...to all patients in accordance with the New York Nurse Practice Act, National Standards of Practice, and Nursing… more
    Trinity Health (08/14/25)
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  • Insurance Specialist - Samaritan Hospital - PD…

    Trinity Health (Troy, NY)
    …requirements for Utilization Management and works collaboratively with Utilization Management/Concurrent Review Nurse , physicians, staff and ... identification of possible concurrent denials, forwards information to the appropriate Utilization Management/Concurrent Review Nurse within identified… more
    Trinity Health (07/26/25)
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  • Registered Nurse 1 Psychiatric (NY Helps),…

    New York State Civil Service (New York, NY)
    Nurse 1 Psychiatric (NY HELPS), New York State Psychiatric Institute, Utilization review , P26749 Occupational Category Health Care, Human/Social Services ... York State NY Zip Code 10032 Duties Description The selected candidate will provide Utilization Review services, including but not limited to conducting daily … more
    New York State Civil Service (08/14/25)
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  • Utilization Management Nurse

    CenterWell (Albany, NY)
    …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
    CenterWell (08/08/25)
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  • Utilization Management Nurse

    CenterWell (Albany, NY)
    …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
    CenterWell (08/02/25)
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  • Asst Utilization Coordinator

    WMCHealth (Valhalla, NY)
    …implementation or investigation of the procedures specified in the Quality Management, Utilization Review and Discharge Planning Program at Westchester Medical ... York State Department of Education, as a registered professional nurse . Training and Experience: three years of experience where...of which must have been in the area of utilization review , quality assurance, risk management or… more
    WMCHealth (08/02/25)
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  • Utilization Management RN

    Guidehouse (New York, NY)
    …based on physician certification + Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis + Performs ... **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:** None **Clearance Required** **:**...None **What You Will Do** **:** + Performs chart review of identified patients to identify quality, timeliness and… more
    Guidehouse (07/25/25)
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