- Amergis (Houston, TX)
- Amergis Healthcare Staffing is seeking a Pediatric Registered Nurse ( RN ) to assume responsibility and accountability for the application of the nursing ... process and the delivery of patient care. The Pediatric Registered Nurse ( RN ) demonstrates ability to make clinical judgments in an effective and efficient… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, ... All Levels + Associates degree required. Bachelor's degree preferred. + Active NYS RN or Registered Dietician or Physical Therapist licensure required. + Minimum… more
- Community Health Systems (Naples, FL)
- Join us as a ** Registered Nurse ( RN ) - Utilization Review position** at Physicians Regional Collier Unit: Utilization Review Shift: Mon-Fri (this is ... for Full and Part-Time roles **Job Summary** The Utilization Review Nurse - RN reviews...patient-centered service and continuous improvement. **Licenses and Certifications** + RN - Registered Nurse -… more
- Catholic Health Services (Melville, NY)
- Overview Position Summary: The Registered Nurse provides safe, direct patient care utilizing the nursing process in the ambulatory setting. The RN provides ... clinical leadership and is a resource for staff. The Registered Nurse must show an uncompromising commitment...staff meetings and huddles as appropriate. + Participates in Hedis , GPRO, and other quality programs as needed +… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Registered Nurse Care Coordinator, Quality Management Full Time, 80 Hours Per Pay Period, Day Shift About Us Covenant Medical Group employs or manages ... a proud member of Covenant Health! Position Summary: The RN Care Coordinator II is responsible for integrating evidenced...coordination services within the scope of practice as a registered nurse meeting all required standards both… more
- UCLA Health (Los Angeles, CA)
- Description The Quality Management Nurse is responsible for conducting comprehensive facility site reviews (FSRs) to ensure compliance with healthcare standards and ... facilitate appropriate Health Education opportunities. Additionally, you will performs HEDIS related activities, Pay for Performance activities, Provider Access and… more
- Banner Health (AZ)
- …employment settings by including remote and hybrid opportunities. As a **Licensed Practical Nurse (LPN)** for **Banner Health Plans** , you will be an integral part ... Management Team** . This assignment-based role focuses on independent chart review and clinical assessment. **Key Responsibilities** : + Independently review… more
- Centene Corporation (Lansing, MI)
- …Licensed Marital and Family Therapist (LMFT), Licensed Certified Social Worker (LCSW), Licensed Registered Nurse ( RN ), Acute Care Nurse Practitioner ... field or equivalent work experience within a managed care environment related to HEDIS record review , quality improvement, medical coding or transferable skill… more
- University of Southern California (Alhambra, CA)
- …InterQual guidelines, and Medicaid/Medicare contracts and benefit systems. Required Licenses/Certifications: + Req Registered Nurse - RN (CA DCA) + Req Basic ... major duties of the Case Manager overlap into inpatient duties including: Concurrent review of all patients to validate that the appropriate patient status is… more
- MyFlorida (St. Petersburg, FL)
- …and Excellence in all aspects of their work. The OPS Advanced Practice Registered Nurse Specialist is responsible for providing comprehensive health care to ... OPS ADVANCED PRACTICE RN SPECIALIST - 64952403 Date: Dec 3, 2025...Participate in quality assurance activities including meetings and peer review . + Ensure cooperation and coordination between Clinical Services… more
- Fallon Health (Lynn, MA)
- …care related field preferred. **License** : Active, unrestricted license as a Registered Nurse in Massachusetts **Certification** : Certification in Case ... and reliable transportation **Experience:** * 1+ years of clinical experience as a Registered Nurse managing chronically ill members or experience in a… more
- Molina Healthcare (Tucson, AZ)
- …quality investigations, preferably in a managed care setting, or equivalent experience * Registered Nurse . License must be active and unrestricted in state of ... initiation and management of interventions (eg, improving patient safety); preparation and review of potential quality of care and critical incident cases; review… more
- Insight Global (Austin, TX)
- …* 1+ yr in care management/ HEDIS /Stars, women's health, or imaging navigation * Active Registered Nurse ( RN ) Compact License and RN License in one ... new program that reviews health risk assessments and supports HEDIS gap closure. In this role, you will conduct...* Minimum of 2+ years' experience working as a Registered Nurse , * 1+ year of experience… more
- ERP International (Barksdale AFB, LA)
- …NP experience after graduation Licensure:** Current, full, active, and unrestricted Registered Nurse license Life Support Certification:** Possess current ARC ... **Overview** ERP International is seeking a ** Nurse Practitioner,** for a Full-Time position supporting **Occupational...deployment status in a private setting. + Conduct pre-deployment review of health record for any conditions that may… more
- Blue KC (Kansas City, MO)
- …+ Experience working for a health plan and/or within a provider office + Registered Nurse and/or medical licensure + Knowledge base of clinical standards of ... experts; and influence provider behavior to achieve needed results. The person will review charts, identify gaps in care, and educate providers and offices to ensure… more
- CareFirst (Baltimore, MD)
- …addition to the required work experience. **Licenses/Certifications Upon Hire Required:** + Health Services\ RN - Registered Nurse - State Licensure and/or ... partnering hospital. This role will assist leadership with the development and review of Care Management standards, program criteria, policies, and procedures to… more
- Centene Corporation (Maumee, OH)
- …insurance experience required; 1+ year quality experience preferred. **License/Certification:** Registered Nurse , Licensed Practical Nurse , Licensed ... states, and have a (2) combination of experience in the following areas: HEDIS , managed care, quality, process improvement/ project management (such as lean, CPHQ,… more
- University of Miami (Miami, FL)
- …Providers supervises advance d practice providers (APPs) ( ie, Advanced Registered Nurse Practitioners, Physician Assistants etc.). Key responsibilities of ... Medicare annual wellness exam documentation preferred + Knowledge of HEDIS Quality Care Gaps - review and...Knowledge of HEDIS Quality Care Gaps - review and closure preferred + Knowledge of Hierarchical Condition… more
- CDPHP (Latham, NY)
- …varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, ... for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources.… more
- CenterWell (Atlanta, GA)
- …to the strategic intent Overseeing other clinicians which includes Physicians, Advanced Registered Nurse Practitioners (ARNP), and Physicians Assistants (PA) in: ... inquiries, requests, and complaints from patients + Ongoing chart review / audit of clinical staff to ensure quality...Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators + Good understanding of best practice… more
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