• RN/Case Manager -MSH-Case…

    Mount Sinai Health System (New York, NY)
    …+ Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ... **Job Description** **RN/Case Manager MSH Case Management FT Days** The Case...a Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management… more
    Mount Sinai Health System (07/15/25)
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  • RN/Case Manager -Inpatient-Mount Sinai…

    Mount Sinai Health System (New York, NY)
    …preferred. + Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ... **Job Description** **RN/Case Manager Inpatient Mount Sinai West FT Days 8a-4p...1. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management… more
    Mount Sinai Health System (07/08/25)
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  • Utilization Case Manager

    Helio Health Inc. (Syracuse, NY)
    …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
    Helio Health Inc. (07/11/25)
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  • Registered Nurse (RN) - Utilization

    Monroe County, NY (Rochester, NY)
    Full Jobs List Full Exams List Registered Nurse (RN) - Utilization Review Unit Location: Rochester, NY Title: Registered Nurse (RN) - Utilization Review ... Hospital Description of Duties This position is in the Utilization Review Unit and functions as an...and works under the general supervision of a Nurse Manager , or other higher-level staff member. General supervision may… more
    Monroe County, NY (08/02/25)
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  • Utilization and Appeals Manager

    Catholic Health Services (Melville, NY)
    …why Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... for 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 resource… more
    Catholic Health Services (07/24/25)
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  • Utilization Manager -OASAS Program

    Samaritan Daytop Village (Rhinebeck, NY)
    …and goal of sustaining high quality care/service delivery to persons served, the Utilization Manager works to assist CASAC Counselors and supervisory staff as ... needed with assuring compliance with external and internal utilization review /quality and appropriateness requirements. What qualifications do you need: +… more
    Samaritan Daytop Village (08/04/25)
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  • Registered Nurse (RN) - Utilization

    Rochester Regional Health (Rochester, NY)
    …able to work independently with minimum direction. + Act as a resource for utilization review stakeholders and assists team members in clinical problem solving. ... Job Title: Registered Nurse IDepartment: Utilization Management Location: Rochester General Hospital Hours Per...standard UM sources for potential inpatient medical necessity denials. Review patient class in the event manager ,… more
    Rochester Regional Health (08/02/25)
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  • Manager of Compliance and Clinical…

    KPH Healthcare Services, Inc. (East Syracuse, NY)
    …pertaining to its state licensure, third party administrators, utilization review and management requirements. The Manager of Compliance and Clinical ... and programs. **Job Summary:** Reporting to the Director of Operations, the Manager of Compliance and Clinical Operations is responsible formaintaining an effective… more
    KPH Healthcare Services, Inc. (05/16/25)
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  • Pharmacist, Utilization Management (UM)

    Molina Healthcare (Buffalo, NY)
    …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing and measuring performance… more
    Molina Healthcare (07/27/25)
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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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