• Healthcare Clinical Documentation Specialist

    Deloitte (New York, NY)
    …Bachelor's degree in nursing, medical degree, or physician assistant required + Current Registered Nurse ( RN ) license required + Certified Clinical ... nurse , physician, physician assistant, case manager, clinical documentation specialist, utilization review , informatics RN , Quality, DRG Validation and… more
    Deloitte (11/21/25)
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  • Denials Prevention Specialist, Clinician PRN

    Datavant (Albany, NY)
    …with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of...by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more
    Datavant (11/12/25)
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  • Professional, Behavioral Health

    MVP Health Care (Schenectady, NY)
    …Master's prepared and licensed mental health clinician (LMSW, LCSW, LMHC, etc.) or Licensed Registered Nurse ( RN ) required + New York State license required ... Workplace** . The Behavioral Health (BH) Professional is responsible for conducting utilization review for mental health and substance use treatment decisions.… more
    MVP Health Care (11/29/25)
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  • Medical Data Entry Manager

    Constructive Partnerships Unlimited (Brooklyn, NY)
    …communication on medical issues with VP of Nursing, Nurse Administrator, Registered Nurse ( RN ), and Medical Coordinators2. Maintains medical records, ... POSITION SUMMARY Under the Supervision of the VP of Nursing and Nurse Administrators, works collaboratively and assists in the management of medical care… more
    Constructive Partnerships Unlimited (09/22/25)
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  • Payment Integrity Clinician

    Highmark Health (Albany, NY)
    …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...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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  • Primary Care Physician (PCP)

    STG International (Kingston, NY)
    …in the management/coordination of the clinic's day-to-day activity, in conjunction with the Registered Nurse ( RN )/CBOC Manager and VA Program's philosophy. + ... safety. + Participates in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health enhancement… more
    STG International (10/08/25)
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  • Primary Care Physician (PCP) - PRN

    STG International (Auburn, NY)
    …in the management/coordination of the clinic's day-to-day activity, in conjunction with the Registered Nurse ( RN )/CBOC Manager and VA Program's philosophy. * ... safety. * Participates in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health enhancement… more
    STG International (09/26/25)
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  • Hyperbaric Oxygen Technologist

    Nuvance Health (Poughkeepsie, NY)
    …license or certification in the respective field of qualifying credential (eg, Registered Nurse , LPN, Respiratory Therapist, EMT or Paramedic) * Maintenance ... care to an assigned group of patients through the utilization Standards of Practice and policies and procedures and...patient care within the scope of practice as a Nurse ( RN or LPN), Respiratory Therapist, EMT,… more
    Nuvance Health (09/10/25)
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  • Case Manager (Inpatient Units)

    Ellis Medicine (Schenectady, NY)
    …for appropriate Level of Care and status on all patients through collaboration with Utilization Review RN + Contacts the attending physician for additional ... The RN Case Manager has responsibility for case management...the Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration… more
    Ellis Medicine (11/26/25)
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  • Appeals Manager

    BronxCare Health System (Bronx, NY)
    …response by the department physician advisors and clinical staff. Qualifications - NYS Registered Nurse required - The Appeal Manager must have excellent verbal ... the department's leadership develop strategies for denial prevention, improved utilization management, documentation of medical necessity and identify patterns and… more
    BronxCare Health System (11/15/25)
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