Utilization Manager Jobs in New York
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Search Results - Utilization Manager Jobs in New York
Capital Rx-New York-mindmatch.ai-
management (PBM) solutions to self-insured employers,
Judi Health , which offers full-service health benefit management solutions to employers, TPAs, and health plans, and
Judi , the industrys leading proprietary Enterprise Health Platform (EHP), which...
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Pride Health-New York-
departments (e.g., Claims, Utilization Management) to investigate and resolve issues.
• Track, manage, and ensure timely follow-up and closure of all inquiries.
• Prepare written responses to provider inquiries and maintain accurate documentation and records...
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PRIDE Health-New York-
Participate in interdisciplinary care planning and quality initiatives
🔹 Collaborate with Utilization Management (UM) and other departments
🔹 Maintain accurate documentation and compliance with regulatory standards
Preferred Qualifications
✔ Leadership...
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PRIDE Health-New York-
in interdisciplinary care planning and quality initiatives
🔹 Collaborate with Utilization Management (UM) and other departments
🔹 Maintain accurate documentation and compliance with regulatory standards
Preferred Qualifications
✔ Leadership experience
✔ Master’s...
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Capital Rx-New York-mindmatch.ai-
understanding of Medicare benefit structures.
Experience testing and validating pharmacy benefit configurations in Commercial, Medicaid, Exchange, and/or Medicare lines of business.
Strong knowledge of formulary design, tier structures, utilization management...
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VNS Health-New York-
departments—including Care Management, Utilization Management, Provider Relations, Compliance, and Analytics—to sustain continuous improvement, advance health equity, and ensure regulatory readiness.
What We Provide
• Referral bonus opportunities...
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New York-icims.com-
operating model, including:
• Firmwide organizational structure and governance with defined levels, centralized oversight, and consistent job standards
• Workload, staffing, and utilization management, ensuring the correct work goes to the correct paralegal...
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New York-vnshealth.org-
staff at all levels including but not limited to, Provider Relations, Utilization Management, Medical Directors, and/or, Care Management, to achieve resolution of appeals and grievances. Works with management in developing long and short-term objectives...
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Glint Tech Solutions LLC-New York-careers-page.com-
IT, and QA teams
• Support interoperability APIs (Prior Authorization focus)
Must Have Skills:
• 8+ years as BA (5+ years in Clinical environment)
• Strong experience with CMS-0057 F mandate
• Utilization Management (UM) & Clinical Operations expertise...
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New York-vnshealth.org-
in public health or health-related field preferred
Work Experience:
Minimum three years progressive professional experience in health care, including a minimum of two years in a grievance and appeals or related area such as medical or utilization management...
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Rockstar-New York-workable.com-
understanding of VBC performance drivers, quality measures, utilization management, and shared savings models.
• Experience working closely with primary care practices and clinical teams.
• Demonstrated ability to lead and develop teams
• High comfort level...
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New York-vnshealth.org-
and eligibility, benefits administration, utilization management, appeals and grievances, care coordination and quality programs, provider contracting and network adequacy and credentialing. and other health plan related matters.
• Keeps abreast and apprises...
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New York-vnshealth.org-
the first six months. Provides feedback to therapist and management; assists in development of plans to address improvement needs as appropriate.
• For Utilization Management Only:
• Issues Determinations, Notices of Action, and other forms...
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New York-vnshealth.org-
role required
• Excellent oral and written communication skills required
• Advanced personal computer skills, including Word, Excel or Access required
• Utilization Management experience preferred
Pay Range: USD $20.98 - USD $26.23 /Hr....
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New York-vnshealth.org-
or Access Required
Utilization Management experience Preferred
Pay Range: USD $20.98 - USD $26.23 /Hr....
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