Utilization jobs in New York

Position Details Position Information Recruitment/Posting Title Utilization Management Coordinator Job Category Staff & Executive - Healthcare - Other Department University Behavioral Health Overview Rutgers University Behavioral Health Care (UBHC), established in 1971, offers a full continuum o

CVS Health

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in e

Overview Oversees the utilization of medical care and treatment of VNS MSO members and provides direction and guidance to the staff to assure appropriate and expedient decision-making with attention to quality of care. Consults and cooperates with internal and external partners. Works under general

Come lead with us at New York, NY The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. The

Overview Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are

Help Drive the Success of Behavioral Health Reimagined Gracie Square Hospital is a leading behavioral health facility in New York City providing comprehensive, personalized healthcare. Through our affiliation with NewYork-Presbyterian and Weill Cornell Medicine, we deliver innovative treatments, hel

A Long Island-based healthcare organization is seeking a licensed Registered Nurse (RN) to join their team in Nassau County as a Case Manager, focusing on coordinating high-quality, cost-effective care for hospitalized patients. About the Opportunity: Schedule: Monday to Friday Hours: 8:30am to 5:30

Thank you for considering Progyny! Progyny is seeking a Utilization Management Summer Intern with a Compliance and Accreditation Focus. The Utilization Management Intern will support Progyny’s UM team with a primary focus on compliance, audit readiness, and accreditation-aligned processes, while gai

Description Job Description This position is responsible for coordinating requests for clinical information from third party payers and providing support to a broad client base, both internal and external to the institution. Position responsibilities will include utilization management support funct

Description This position is responsible for coordinating requests for clinical information from third party payers and providing support to a broad client base, both internal and external to the institution. Position responsibilities will include utilization management support functions for patient

City/State: Mount Vernon, New York Grant Funded: No Department: MMV Medical Management Work Shift: Day Work Days: PER DIEM Scheduled Hours: 8:30 AM-5 PM Scheduled Daily Hours: 7.5 HOURS Hourly Rate: $34.00 For positions that have only a rate listed, the displayed rate is the hiring rate but could be

CalOptima

Behavioral Health Utilization Management Medical Case Manager CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community‐based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready

POSITION SUMMARY: Performs concurrent utilization review activities on all patients within the assigned caseload. Collaborates and educates the medical staff on appropriate utilization review guidelines and documentation in accordance with CMS regulations and Commercial payors guidelines. Monitors a

Overview Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are

HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, servin

Must Have Technical/Functional Skills Data Scientist to build a Predictive Benefit Utilization Model and an Attribution Model leveraging Microsoft Fabric, with the objective of improving accuracy over current manual / Excel‑based projections and enabling data‑driven executive decision‑making Roles &

Hackensack Meridian Health

Overview Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are

Who are we? MATTE is a 360° full-service creative studio at the convergence of hype, storytelling and design. We bring people together to inspire new ways of engaging, to provoke long term progress, and to entertain audiences around the world, while helping forward-thinking brands and institutions n

Dane Street, a nationally recognized Independent Review Organization (IRO), is expanding its panel of Physician Reviewers. We are currently seeking Board-Certified Orthopedic Spine Surgeons with an active New York medical license and Workers’ Compensation Board Certification to conduct Utilization R

ABOUT THE ROLE: Our PBM goal is to help clients better manage pharmacy spend to make drugs more affordable for their employees and dependents. Rightway is responsible for designing, building, and operating a new-to-the-world PBM model based on our core tenets: fairness & transparency, unlocking