1w
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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.
3w
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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.
1mo
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Utilization Management Nurse Registered
Woodland Park or Paterson
$49-$74/hr OnsiteFull Time
3+ YOEBachelor of Science in Nursing, NJ RN license, minimum 3 years nursing experience; 3+ years utilization review or case management preferred; CCM preferred.
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
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
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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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
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
2w
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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 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.
1w
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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.
1mo
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Utilization Management Specialist-MSH-Case Management-FT-Days
New York, New York, United States
$23-$34/hr OnsiteFull Time
2+ YOEAssociates degree or equivalent (Bachelors preferred), 2+ years relevant experience, coordinating payer communications, denial management, data entry into tracking/EMR systems.
EMR
1mo
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Utilization Management Specialist-MSH-Case Management-FT-Days
New York, New York, United States
$23-$34/hr OnsiteFull Time
2+ YOEAssociates degree or equivalent (Bachelors preferred), 2+ years relevant experience, experience with EMR and data entry, payer authorization and denial management skills, strong communication.
Microsoft Office Suite, EMR
3w
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OP Enforcement Manager
New York or New York
$160k-$170k/yr OnsiteFull Time
7+ YOEBachelor's in electrical or power system engineering,7+ years utility experience in planning or operations,PE or NERC operator cert preferred,ability to assess risk and communicate technical findings.
Microsoft Office
2mo
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Utilization Review and Appeals Case Manager
Stony Brook, New York, United States
$90k-$128k/yr OnsiteFull Time
4+ YOERN with 3-5 years acute care; NY RN license;Bachelor's degree; knowledge of InterQual/MCG; strong communication; proficient in Word/Excel; weekend flexibility
Microsoft Word, Microsoft Excel, PowerPoint, Electronic Medical Records (EMR)
2mo
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Associate Medical Director, Utilization Management
New York or Florida or Arizona or North Carolina
$240k-$315k/yr RemoteFull Time
3+ YOEBoard-certified MD or DO with unrestricted license, 3+ years clinical practice, 2+ years utilization review experience, ability to manage physicians, and willingness to obtain state licensure; strong documentation and clinical judgment.
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