• Registered Nurse ( RN )…

    Rochester Regional Health (Rochester, NY)
    Job Title: Registered Nurse IDepartment: Utilization Management Location: Rochester General Hospital Hours Per Week: 40 hours (Full-Time)Schedule: Monday ... Responsibilities include concurrent (as needed) and retrospective reviews. The Utilization Management Nurse will act...- Basic Life Support - American Heart Association (AHA), RN - Registered Nurse -… more
    Rochester Regional Health (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** **:**...License - REQUIRED + 4+ years of experience in utilization management + Familiarity with MCG and… more
    Guidehouse (07/25/25)
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  • RN , Utilization Management

    University of Rochester (Rochester, NY)
    …qualifications, expertise of the individual, and internal equity considerations._ **Responsibilities:** The Utilization Management (UM) RN position spans the ... Type: Full time Scheduled Weekly Hours: 40 Department: 500009 Utilization Management Work Shift: Range: UR URCB...is remote with some on-site requirements as needed. Qualifications: RN with Utilization Review experience… more
    University of Rochester (08/07/25)
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  • Utilization Management Nurse

    CenterWell (Albany, NY)
    … RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous… more
    CenterWell (08/08/25)
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  • Utilization Management Nurse

    CenterWell (Albany, NY)
    …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... as a whole. Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous… more
    CenterWell (08/02/25)
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  • RN Utilization Review…

    Guthrie (Binghamton, NY)
    …services regarding admissions, case management , discharge planning and utilization review . Responsibilites: Reviews admissions and service requests within ... planning needs with healthcare team members. May prepare statistical analysis and utilization review reports as necessary. Oversees and coordinates compliance to… more
    Guthrie (07/05/25)
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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 ... acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of… more
    CDPHP (08/03/25)
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  • 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 ... of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them...beneficiary and the Network Provider. + Provides first level RN review for all outpatient and ancillary… more
    Centene Corporation (08/02/25)
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  • 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, ... care to MCC in response to physician order, or review of updated clinical information Acts as a resource...current with industry standards and business objectives related to Utilization and Care Management as appropriate. Sound… more
    Catholic Health Services (07/24/25)
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  • Registered Nurse ( RN ) Case…

    Northwell Health (Riverhead, NY)
    …to another level of care according to regulatory standards. + * Performs concurrent utilization management + Conducts chart review for appropriateness of ... license to practice as a Registered Professional Nurse in New York State. + Case Management... and clinical pathways, variance analysis and trending, quality management / utilization review and home care/discharge… more
    Northwell Health (07/25/25)
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