• 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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  • 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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  • Insurance Specialist-Mount Sinai West-…

    Mount Sinai Health System (New York, NY)
    **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front end operations of the Case Management Department by ... Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. Clinical/Technical/Service**… more
    Mount Sinai Health System (07/23/25)
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  • Clinical Review Nurse - Concurrent…

    Centene Corporation (New York, NY)
    …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... health management systems according to utilization management policies and guidelines + Works with healthcare...or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers… more
    Centene Corporation (08/02/25)
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  • Care Review Clinician, Prior Auth (RN) Pega…

    Molina Healthcare (Yonkers, NY)
    …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical… more
    Molina Healthcare (07/12/25)
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  • Nurse Practitioner-Inpatient…

    Mount Sinai Health System (New York, NY)
    **Job Description** **Job Title: Nurse Practitioner-Inpatient Hematology/Oncology -Mount Sinai Hospital - Full Time - Day Shift (3 12 hr)** A nurse practitioner ... nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and...the plan of care. + Performs a patient record review with the collaborating physician in a timely fashion… more
    Mount Sinai Health System (07/27/25)
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  • Nurse Practitioner - Pediatric Cardiac…

    Mount Sinai Health System (New York, NY)
    **Job Description** A nurse practitioner (NP) as described in Title VIII, Article 139 section 6910 of the New York Education Law is a RN who has earned a separate ... nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and...the plan of care. 11. Performs a patient record review with the collaborating physician in a timely fashion… more
    Mount Sinai Health System (07/18/25)
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  • Registered Nurse -Quality Management- Renal…

    Veterans Affairs, Veterans Health Administration (Bronx, NY)
    …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Medical Center is recruiting for 1 Quality Management Registered Nurse for the Renal Transplant Program. At the full...clinical expertise to improve quality of care and resource utilization at the expert level with improved outcomes beyond… more
    Veterans Affairs, Veterans Health Administration (07/31/25)
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  • Nurse Practitioner - Cardiovascular…

    Mount Sinai Health System (New York, NY)
    **Job Description** A nurse practitioner (NP) as described in Title VIII, Article 139 section 6910 of the New York Education Law is a RN who has earned a separate ... nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and...the plan of care. 11. Performs a patient record review with the collaborating physician in a timely fashion… more
    Mount Sinai Health System (07/04/25)
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