• Utilization Management

    Crouse Hospital (Syracuse, NY)
    …and outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse ( RN ) to track and manage data ... occasional weekends (typically requires 6 weekends a year). Utilization Management Registered Nurse ( RN ) Position Responsibilities: + Works… more
    Crouse Hospital (03/20/25)
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  • Utilization Management Nurse

    CVS Health (Albany, NY)
    …active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include weekends, ... all with heart, each and every day. Position Summary Utilization Management is a 24/7 operation and...**Required Qualifications** + 2+ years of experience as a Registered Nurse in adult acute care/critical care… more
    CVS Health (06/01/25)
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  • Utilization Management RN

    Ellis Medicine (Schenectady, NY)
    Basic Function: The Utilization Management Registered Nurse (UM RN ) supports daily coordination of care across healthcare continuum with the ... preoperative, concurrent and retrospective reviews in accordance with the utilization management program. The UM RN...care related field required. Current registration as a Licensed Registered Professional Nurse in New York State.… more
    Ellis Medicine (04/03/25)
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  • Assistant Director of Case Management

    Mount Sinai Health System (New York, NY)
    …and efficient care to patients, the delivery of comprehensive front-line Case Management services, including utilization management , care facilitation and ... field, Master's degree preferred + 5 years of Case Management and 6 years as a clinical nurse... management is preferred Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West… more
    Mount Sinai Health System (04/04/25)
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  • Behavioral Health Care Manager I…

    Elevance Health (Middletown, NY)
    …to improve the delivery of care. **Title** : Behavioral Health Care Manager- Utilization Management **Location:** **Virtual** : This role enables associates to ... equivalent background. + Current active unrestricted license, such as RN LCSW LMSW LMHC LPC LBA (as allowed by...Skills, Capabilities and Experiences:** + Previous experience in case management / utilization management with a broad… more
    Elevance Health (05/28/25)
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  • RN Utilization Review - System Care…

    Guthrie (Binghamton, NY)
    …necessary. Oversees and coordinates compliance to federally mandated and third party payer utilization management rules and regulations The pay range for this ... Provides health care services regarding admissions, case management , discharge planning and utilization review. Responsibilites: Reviews admissions and service… more
    Guthrie (04/05/25)
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  • Utilization Management Nurse

    CVS Health (Albany, NY)
    …is a fully remote position. The requirements is for candidates to hold a **New York Registered Nurse ** License. This employee will work four - 10 hour days per ... with heart, each and every day. **Position Summary** This ** Utilization Manager** position is with Aetna's Long-Term Services and...week. This role is a registered nurse that utilizes MCG rules and… more
    CVS Health (06/01/25)
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  • Utilization Review Nurse

    Albany Medical Center (Albany, NY)
    …Day (United States of America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management , Quality Screening and Delay Management for ... assigned patients. * Completes Utilization Management and Quality Screening for assigned patients.* Applies MCG...with Triad Team and health care team. Minimum Qualifications:* Registered nurse with a New York State… more
    Albany Medical Center (04/25/25)
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  • Utilization Review Nurse

    Independent Health (Buffalo, NY)
    …Degree in Nursing required; Bachelor's degree preferred. Current, active, unrestricted, and licensed registered nurse ( RN ) required. + Two (2) years of ... Collaborative and Accountable. **Essential Accountabilities** Provide High Quality, Professional Utilization Management Services: (Medical necessity review for… more
    Independent Health (05/22/25)
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  • CHS Utilization and Appeals Manager

    Catholic Health Services (Melville, NY)
    …queries from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, ... accredited Nursing School or College; current New York State, RN License required, BSN Bachelor of Science in Nursing...current with industry standards and business objectives related to Utilization and Care Management as appropriate. Sound… more
    Catholic Health Services (03/19/25)
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