3d
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Utilization Review
Marlboro Township, New Jersey, United States
OnsiteFull Time
2+ YOE2+ years utilization review, case management, medical billing, or behavioral healthcare experience preferred; high school diploma required; knowledge of Medicaid, commercial insurance, ASAM criteria; strong communication and organizational skills.
Microsoft Office, Electronic Health Record (EHR)
2mo
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Director, Utilization Management
New York, New York, United States
$155k-$237k/yr OnsiteFull Time
Senior-level leadership in utilization management with healthcare regulatory knowledge.
1w
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Utilization Review Coordinator
Parsippany, New Jersey, United States
$33/hr OnsiteFull Time
2+ YOEBachelor's required (master's preferred), 2+ years behavioral health or utilization review experience, familiarity with insurance authorization and medical necessity, strong documentation and communication skills.
3mo
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Utilization Management RN
Paterson, New Jersey, United States
OnsiteFull Time
3+ YOEBSN required; 3+ years nursing experience; 3+ years utilization review/case management preferred; CCM certification preferred; NJ RN licensure required.
2w
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Utilization Management Coordinator
Piscataway, New Jersey, United States
$71k-$101k/yr HybridFull Time
3+ YOERequires RN license in New Jersey or Bachelor's in mental health, 3+ years mental health experience, utilization review and data entry skills preferred, ability to conduct reviews and communicate outcomes.
3mo
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Utilization Review Nurse (Medicare)
Spring Valley, New York, United States
$41-$47/hr OnsiteFull Time
2+ YOERN with Medicare experience; 2+ years in utilization review; NY license; BSN preferred.
Medicare guidelines, N/A
2mo
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Utilization Manager
Queens, New York, United States
$35-$38/hr OnsiteFull Time
1+ YOEHigh School Diploma or GED; CASAC or ability to obtain CASAC (T) within 6 months; 1+ year clinical or quality assurance experience; knowledge of HIPAA, OASAS, and 42 CFR; MS Office and EHR proficiency; ability to work with diverse populations; strong communication skills; bilingual Spanish a plus.
2mo
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Care Coordinator, Utilization Management
Edison, New Jersey, United States
$106k/yr OnsiteFull Time
Coordinate care, review utilization, communicate with payors to manage patient progression.
Epic, Xsolis Cortex, Enterprise Analytics, Google Suites
1mo
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RN Utilization Review Specialist
Nyack, New York, United States
$110k/yr OnsiteFull Time
4+ YOENY registered nurse required; performs utilization management, discharge planning, concurrent reviews using Interqual, documents medical necessity, coordinates care across team; 4-6 years clinical experience preferred.
Interqual, Care Management database, H/C PRI/Screen
1mo
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Placement & Utilization Support Coordinator
New York, New York, United States
$41k-$45k/yr HybridFull Time
1+ YOE1 year customer service experience required; healthcare experience preferred. Familiarity with utilization/case management, HealthRules Payor, Microsoft Word and Excel, 55 wpm typing, and strong customer service and interdisciplinary teamwork skills.
HealthRules Payor, Microsoft Word, Microsoft Excel
1mo
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Placement & Utilization Support Coordinator
New York, New York, United States
$41k-$45k/yr OnsiteFull Time
1+ YOE1 year customer service experience required; healthcare experience preferred. Familiarity with utilization/case management, HealthRules Payor, Microsoft Word and Excel; typing 55 wpm; strong customer service and interdisciplinary teamwork skills.
HealthRules Payor, Microsoft Word, Microsoft Excel
2mo
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Senior Manager, Utilization Management
New York, New York, United States
OnsiteFull Time
6+ YOE3+ MgmtBachelor's degree plus RN license; 6+ years in Utilization/Case Management/Appeals within managed care; 3+ years of leadership; Milliman guidelines knowledge; strong decision-making, communication, and MS Office skills.
Microsoft Office
2mo
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CHS Utilization and Appeals Manager
Melville, New York, United States
$110k-$150k/yr OnsiteFull Time
5+ YOERN with 5+ years clinical/appeals experience; strong knowledge of utilization and care management; proficient in EPIC/Midas/Star; excellent communication and regulatory understanding.
EPIC, Midas, Star
2mo
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CHS Utilization and Appeals Manager
Melville, New York, United States
$110k-$150k/yr OnsiteFull Time
5+ YOERN with 5+ years in clinical utilization/care management and appeals; managed care experience; EPIC/Midas/Star familiarity; NY RN license; BSN preferred.
EPIC, Midas, Star, Word processing, Spreadsheet
3mo
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Utilization Review Specialist
Westchester, New York, United States
OnsiteFull Time
1+ YOEOne year experience in Healthcare and/or Managed Care setting. Undergraduate/Bachelor Degree in Human or Health Services.
2mo
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Utilization Review Assistant
New York, New York, United States
$27-$34/yr OnsiteFull Time
3+ YOEAdministrative support in healthcare; HS diploma or GED with 3 years experience or associate degree; strong organization; proficient in MS Office and EHR; excellent communication.
Microsoft Word, Excel, Electronic Health Records, Outlook
1w
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Manager of Utilization Review and Case Management Professional Development
Patchogue, New York, United States
$85k-$128k/yr OnsiteFull Time
NYS registered nurse license required; experience coordinating utilization review, discharge planning and resource management; proficiency with EPIC, CarePort, Indicia, MCG, Microsoft PowerPoint, Excel and Word; education and staff development experience.
EPIC, CarePort, Indicia, MCG, Microsoft PowerPoint, Microsoft Excel, Microsoft Word
1w
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Utilization Review Coordinator – Behavioral Health
Toms River, New Jersey, United States
OnsiteFull Time
1+ YOEHigh school diploma (Bachelor's preferred), 1+ year behavioral health/treatment experience preferred, strong communication and documentation skills, CPR/First Aid and valid driver license, healthcare or nursing background preferred.
5d
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Utilization Review RN Per Diem
New Brunswick, New Jersey, United States
$51/hr OnsitePart Time
3+ YOEActive New Jersey RN license, 3+ years acute care nursing experience, ability to assess clinical records for medical necessity, strong communication and computer skills.
6d
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Director of Utilization Management
New York City or New Jersey or Connecticut
$118k-$133k/yr HybridFull Time
3+ YOE5+ MgmtMinimum 5 years management in health-related field, 3 years quality management, Bachelor's required (Master's preferred), active NYS RN license or willing to obtain within 3 months, experience analyzing data and knowledge of Medicare/Medicaid quality regulations.
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