Utilization management Jobs in New York, NY

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Registered Nurse | Utilization Management Appeals Nurse | Remote | Contract

Walker Healthforce

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Remote

Contract

Utilization Management Appeals Nurse | 2 years experience | Remote | Contract Walker Healthforce is seeking a Utilization Management Appeals Nurse with 2 years of experience to support a healthcare client based out of New Jersey. This is a 6-month contract opportunity. START DATE: 6/1/2025 HOURS/SCHEDULE: 8am-5pm EST Monday- Friday WORKER TYPE: W2 CORE REQUIREMENTS: Requires Prior Authorization Experience Minimum of two (2) years clinical experience 3 - 5 years of experience with a background
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Posted 60+ days ago | Updated 1 hour ago

Case Manager - RN - Inpatient Units- Brooklyn Methodist - Days

NewYork-Presbyterian

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Brooklyn, New York, USA

Full-time

Discover Where Amazing Works Case Manager - RN - Inpatient Units- Brooklyn Methodist - Days Located in Park Slope, Brooklyn, this acute-care teaching hospital has been providing outstanding medical care to the surrounding communities for over 135 years. The Case Manager is responsible for all aspects of discharge planning and utilization management/review for an assigned group of patients to determine the appropriateness of the admission and continued stay, assist in the development of the pl
Posted 2 days ago | Updated 15 hours ago

Case Manager - RN - Inpatient Units- Brooklyn Methodist - Days

NewYork-Presbyterian

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Brooklyn, New York, USA

Full-time

Discover Where Amazing Works Case Manager - RN - Inpatient Units- Brooklyn Methodist - Days Located in Park Slope, Brooklyn, this acute-care teaching hospital has been providing outstanding medical care to the surrounding communities for over 135 years. The Case Manager is responsible for all aspects of discharge planning and utilization management/review for an assigned group of patients to determine the appropriateness of the admission and continued stay, assist in the development of the pl
Posted 2 days ago | Updated 15 hours ago

Prior Auth Nurse (RN)

Pyramid Consulting, Inc.

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Remote

Contract

Immediate need for a talented Prior Auth Nurse (RN). This is a 03+months contract opportunity with long-term potential and is located in Olympia, WA (Remote). Please review the job description below and contact me ASAP if you are interested. Job ID:25-80708 Pay Range: $37 - $40/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location). Key Responsibilities: Performs medical necessity and cli
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Posted 1 day ago

Senior Medical Director Health Plan Analytics & Policy Strategy

Ztek Consulting

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Remote

Part-time

Job title: Senior Medical Director Health Plan Analytics & Policy Strategy role Location: Remote Department: Medical Management / Payment Integrity Reports to: Chief Clinical Officer or SVP of Medical Affairs Experience Level: 10+ years in a senior leadership role within health plan or payer environments Position Overview: We are seeking a strategic, data-driven Senior Medical Director with deep expertise in health plan operations, medical policy development, and cost management analytics. This
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Posted 1 day ago

Epic Tapestry Membership Application Analyst II-(Open to experienced remote in ID, NE, MO, OK, TX)

PIH Health

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Remote or Whittier, California, USA

Full-time

Determination for the Epic Application Analyst (I, II or ), Tapestry Membership roles will be based on experience and qualifications. Not currently working with 3rd party recruitment agencies. For immediate consideration email resume to PIH Health internal applicants or Altera employees (working at PIH Health as of May 2025), Epic certification in the required application/module must be obtained within 120 days of hire or transfer into the position. Failure to obtain certification within this ti
Posted 1 day ago

Epic Application Analyst I, II, III, Tapestry Core Administration-(Open to experienced remote in ID, NE, MO, OK, TX)

PIH Health

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Remote or Whittier, California, USA

Full-time

Not currently working with 3rd party recruitment agencies. For immediate consideration email resume to or PIH Health internal applicants or Altera employees (working at PIH Health as of May 2025), Epic certification in the required application/module must be obtained within 120 days of hire or transfer into the position. Failure to obtain certification within this timeframe may result in removal from the position; however, the employee will be eligible to apply for other internal openings for w
Posted 1 day ago | Updated 18 hours ago

Epic Tapestry Medical Management Application Analyst II-(Open to experienced remote in ID, NE, MO, OK, TX)

PIH Health

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Remote or Whittier, California, USA

Full-time

Determination for the Epic Application Analyst (I, II or ), Tapestry Medical Management roles will be based on experience and qualifications. Not currently working with 3rd party recruitment agencies. For immediate consideration email resume to PIH Health internal applicants or Altera employees (working at PIH Health as of May 2025), Epic certification in the required application/module must be obtained within 120 days of hire or transfer into the position. Failure to obtain certification within
Posted 1 day ago | Updated 18 hours ago

Senior Network Pricing Analyst - Hybrid in Las Vegas, NV

UnitedHealth Group

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Remote or Las Vegas, Nevada, USA

Full-time

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. Why work for the leading organization in health care to help improve the lives of millions? You'll fin
Posted 18 days ago | Updated 8 hours ago

Data Analyst II Medical Economics

Centene Corporation

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Florida, USA

Full-time

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Analyze integrated and extensive datasets to extract value, which directly impacts and influences business decisions. Work collaboratively with key business stakeholders to identify areas of v
Posted 26 days ago | Updated 8 hours ago

Data Analyst III Medical Economics

Centene Corporation

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Missouri, USA

Full-time

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Analyze integrated and extensive datasets to extract value, which directly impacts and influences business decisions. Work collaboratively with key business stakeholders to identify areas of v
Posted 47 days ago | Updated 8 hours ago

Registered Nurse | Field Case Manager | Hybrid | Essex County, NJ | Contract

Walker Healthforce

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Remote

Contract

Field Case Manager Registered Nurse | 2+ years | Onsite | New Jersey | Contract Walker Healthforce is seeking a Field Case Manager Registered Nurse with 2+ years of experience to support a healthcare client based out of New Jersey. This is a 6-month contract opportunity. START DATE:8/4/2025 RATE RANGE: $43-$53 HOURS/SCHEDULE: Will be in the field 5 days a week (8am-5pm/9am-5pm) seeing on average 3-4 members a day in their homes for assessment in Essex and Passaic Counties. A scheduler will be p
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Posted 18 days ago | Updated 18 days ago

Fulltime - Utilization Analyst (Medical)- Remote - Elkridge, MD (Citizen & Permanent Ressidence ONLY)

Elite Technical

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Remote

Full-time

Utilization Analyst (Medical)Elite Technical is seeking a Medical/Clinical Utilization Analyst to support our customer, a health plan in the BWI Maryland area. The selected candidate will assure that our client health plan-s remains competitive by identifying, designing, recommending, implementing and evaluating health care programs that control utilization and benefit expense. This position is responsible for the identification, design, development, implementation and evaluation of programs tha
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Posted 2 days ago

RxCLAIM SME

Data Wave Technologies Inc

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US

Contract

Job Title: RxCLAIM SME Location: Remote Duration: Long term Tax Term: W2 Key Technology: RxClaim, PBM Job Responsibilities: Act as a subject matter expert in pharmacy benefit plan design across RxCLAIM or similar adjudication platforms. Create Current state flows for each functional component and their interactions with benefit build process within RxCLAIM and downstream applications. Develop and document plan designs including tier structure, copays, accumulators, exclusions, step therapy,
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Posted 1 day ago

Medical Director

Pegasus Knowledge Solutions

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Remote

Full-time

SummaryThe Medical Director serves a clinical leader across all Client companies and is responsible for medical oversight of the physical medicine network and utilization review, telephonic triage, first notification of loss, bill review and case management services. This role ensures that injured worker care is medically appropriate, evidence-based, cost-effective, and compliant with jurisdictional guidelines. Key Responsibilities Clinical Oversight Provide medical guidance on complex or high-c
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Posted 14 days ago

Chief Engineer

JLL

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Woodcliff Lake, New Jersey, USA

Full-time

JLL empowers you to shape a brighter way. Our people at JLL and JLL Technologies are shaping the future of real estate for a better world by combining world class services, advisory and technology for our clients. We are committed to hiring the best, most talented people and empowering them to thrive, grow meaningful careers and to find a place where they belong. Whether you've got deep experience in commercial real estate, skilled trades or technology, or you're looking to apply your relevant e