• Utilization Review Nurse

    CDPHP (Latham, 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 ... of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must… more
    CDPHP (09/06/25)
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  • Utilization Review Nurse

    Albany Medical Center (Albany, NY)
    …stays, and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... States of America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients. *… more
    Albany Medical Center (09/12/25)
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  • Utilization Management Rep II

    Elevance Health (Latham, NY)
    …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. + ... ** Utilization Management Representative II** **Location:** Virtual: This role...Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and… more
    Elevance Health (09/11/25)
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  • Care Review Clinician, Prior Auth (RN) Pega…

    Molina Healthcare (Albany, 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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  • Medical Claim Review Nurse (RN)

    Molina Healthcare (Albany, NY)
    …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience,… more
    Molina Healthcare (09/06/25)
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  • UM Behavioral Health Nurse

    Humana (Albany, NY)
    …a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support ... communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work assignments… more
    Humana (09/09/25)
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  • Registered Nurse - Accreditation Quality…

    Veterans Affairs, Veterans Health Administration (Albany, NY)
    Summary The Albany VAMC is looking to fill (1) Registered Nurse - ACCREDITATION QUALITY SPECIALIST This job announcement is open only for current, full time, ... with driving requirements for this position. Responsibilities The Registered Nurse Accreditation Quality Specialist executes leadership that is characterized by… more
    Veterans Affairs, Veterans Health Administration (09/12/25)
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  • Nurse - Dialysis

    Veterans Affairs, Veterans Health Administration (Albany, NY)
    …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Responsibilities The Dialysis Registered Nurse (RN) is a professional nurse with...education, orientation, competencies and providing quality improvement and outcomes utilization . Practice includes directing other providers. Partners with the… more
    Veterans Affairs, Veterans Health Administration (08/10/25)
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  • Registered Nurse - Med/Surg

    Veterans Affairs, Veterans Health Administration (Albany, NY)
    …education, orientation, competencies and providing quality improvement and enhance outcomes utilization . This nurse integrates knowledge, skills, abilities, and ... determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply.… more
    Veterans Affairs, Veterans Health Administration (06/24/25)
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  • Nurse Practitioner - Psychiatry

    Northern Rivers Family Services (Troy, NY)
    …county and community partners, and participate in any quality audit and utilization review + Provide on-site/community based/home visits, medication evaluations, ... Nurse Practitioner - Psychiatry Job Details Job Location...and education to staff + Prescribe medications, monitor, and review of drug regimen for enrolled individuals + Participate… more
    Northern Rivers Family Services (08/14/25)
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