• Leader, Concurrent Review

    MVP Health Care (Schenectady, NY)
    …+ Minimum 4 years of clinical nursing experience. + At least 2 years in utilization management sub-acute care review . + 2+ years of supervisory experience + ... To achieve this, we're looking for a **Leader, Concurrent Review ** to join #TeamMVP. If you have a passion...**Qualifications you'll bring:** + Current and unrestricted NY, VT RN license. + Associate or bachelor's degree in nursing… more
    MVP Health Care (09/30/25)
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  • Nurse Case Manager

    Nuvance Health (Carmel, NY)
    …RN experience in an acute care setting; Leadership experience preferred; Utilization review , discharge planning or case management experience preferred. ... affiliates, Education: BSN / BSW preferred 1.Licensure/Registration/Certification:NYS Licensure as RN required; LMSW /LCSW preferred; Case management certification preferred.… more
    Nuvance Health (09/10/25)
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  • LPN - Wellness

    Guthrie (Binghamton, NY)
    …autonomy in nursing practice. + Preferred experience with care management/ utilization review , and payer knowledge. + RN considered. Education: + Completion ... Up to a $15,000.00 Sign on Bonus!! Summary: The Wellness Nurse plays a key role in health promotion and illness prevention of patient populations through… more
    Guthrie (09/26/25)
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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 ... with: law enforcement personnel, EMS, Medical Center security, ED RN staff, and family members. SW Clinician - is...computer is preferred. Required Certification/Registration: + Currently license and registered in NY State to practice as a social… more
    Garnet Health (09/08/25)
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  • Pharmacy Benefit Consultant

    Highmark Health (Albany, NY)
    …**Preferred** + 5 years of experience with communications + 3 years of experience in Utilization Review + 3 years of experience in Account Support + 1 year ... **Required** + None **Preferred** + PA clinical licensure/certifications such as RN , RD, Pharmacist **Language (Other than English):** None **Travel Requirement:**… more
    Highmark Health (08/26/25)
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  • Care Review Clinician, Inpatient…

    Molina Healthcare (Albany, NY)
    …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary… more
    Molina Healthcare (09/25/25)
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  • Utilization and Appeals Manager

    Catholic Health Services (Melville, NY)
    …Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals ... additional clinical documentation. + Acts as liaison between the Utilization and Appeals Management Department and the physician of...care to MCC in response to physician order, or review of updated clinical information + Acts as a… more
    Catholic Health Services (07/24/25)
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  • RN Lead, Healthcare Services

    Molina Healthcare (Buffalo, NY)
    …and at least 2 years of managed care experienced in utilization management * Registered Nurse ( RN ) ONLY if required by state contract, regulation or ... skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse ( RN ). License must be active and… more
    Molina Healthcare (09/26/25)
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  • RN - HIV Medicine Office

    Albany Medical Center (Albany, NY)
    …Aids Program Work Shift: Day (United States of America) Salary Range: $83,200.00 - $128,960.00 Registered Nurse ( RN ) - Full time HIV Medicine Clinic - ... advanced practice provider (APP) and the supervision of the Nurse Manager ( RN ) and/or Nurse ...Nursing program is required* Current NYS license as a Registered Nurse Thank you for your interest… more
    Albany Medical Center (08/22/25)
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  • RN , Quality Assurance

    University of Rochester (Rochester, NY)
    …- Quality Assurance and Process Improvement (QA/PI) experience preferred LICENSES AND CERTIFICATIONS - RN - Registered Nurse - State Licensure and/or Compact ... of strict inclusion/exclusion criteria and protocols. Performs meticulous chart review and enters clinical data into the quality databases...State Licensure Current licensure as a Registered Nurse in NYS upon hire required… more
    University of Rochester (08/07/25)
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