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.
3mo
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Utilization Manager
Ellenville, New York, United States
$36-$40/hr RemoteFull Time
1+ YOEHigh school diploma; CASAC or eligible within 6 months; 1+ year clinical/QA in behavioral health; HIPAA/OASAS/42 CFR knowledge; proficient in MS Office and EHR; Spanish a plus.
Microsoft Office, EHR, Quality Assurance Systems
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
3mo
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Utilization Review Nurse
Albany, New York, United States
$72k-$111k/yr OnsiteFull Time
3+ YOERegistered nurse with NY license; associate degree; 3 years clinical experience; utilization management/case management/ discharge planning experience preferred; PRI and case management certification preferred; strong communication; knowledge of MCG criteria, ICD-10 coding, and Medicare rules.
EMR, MCG criteria, ICD-10 coding, Medicare regulations
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
2mo
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Director, Utilization Management
New York, United States
$128k-$237k/yr HybridFull Time
Bachelor’s degree; progressive healthcare leadership; strong knowledge of UM, DOH/CMS regulations; experience with payer guidelines; excellent communication and change management skills.
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.
1mo
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Utilization Review Nurse- Care Coordination Department
Poughkeepsie, New York, United States
$48-$74/hr HybridFull Time
3+ YOEActive NY RN license, Associate degree in nursing, 3+ years acute/subacute nursing experience, utilization management experience preferred, proficiency with Cerner, InterQual/MCG knowledge, CCM/ACM preferred, NYS PRI required within 60 days, HIPAA compliance.
Cerner, InterQual, MCG
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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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 Nurse Consultant
Michigan or Mississippi or Pennsylvania or North Carolina or Maryland or Minnesota or Nebraska or Missouri or Colorado or New York or New Jersey or Arizona or Connecticut or Texas or District of Columbia or Florida or Rhode Island or Iowa or Alaska or Arkansas or South Dakota or Idaho or Illinois or Kansas or Tennessee or Virginia or Delaware or Wisconsin or Georgia or West Virginia or Oregon or Oklahoma
$29-$62/hr RemoteFull Time
3+ YOEActive unrestricted RN license in state of residence, 3+ years Med-Surg RN hospital experience, Associates in Nursing required (BSN preferred), 1+ year Microsoft Office (Outlook, Teams, Excel) experience, ability to work multiple IT platforms.
Microsoft Outlook, Microsoft Teams, Microsoft Excel
2mo
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Utilization Management Reviewer (RN) - Multiple Positions!
Albany or Jamestown or Rochester or Binghamton or Buffalo or Utica or Dewitt
$62k-$107k/yr HybridFull Time
3+ YOEAssociates degree; NY RN license required; 3+ years clinical experience; UM experience preferred; proficient with Microsoft Office; knowledge of coding standards and government contracts.
Microsoft Office Suite, Coding standards
1mo
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Vice President, Quality Improvement & Utilization Management
Rome, New York, United States
$157k-$204k/yr HybridFull Time
10+ YOE5+ Mgmt10+ years healthcare quality/UM experience with 5+ years director/VP-level health plan leadership; Bachelor's required (Master's preferred); expertise in CMS Stars, HEDIS, NYS MLTC, UM operations; strong analytics and communication.
Microsoft Office, InterQual, Milliman
2mo
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Utilization Management Services Rep I
Rochester or Buffalo or Utica or Dewitt or Elmira or Binghamton
$20-$27/hr HybridFull Time
High school diploma; call center experience preferred; strong analytical, written and verbal communication skills; able to work independently and in teams; experience in managed care is a plus.
Facets, PEGA, Care Advance Provider Tool
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