- Novo Nordisk Inc. (Boston, MA)
- …systems and ability to discuss economics of hospital and/or group, including quality metrics, as needed Ability to view, manipulate and extract actionable insights ... Inform health system decision makers, influencers and stakeholders hospital faculty, medical students, residents, interns as well as attending physicians, nurse… more
- Essentia Health (Detroit Lakes, MN)
- …Essentia Health in home health for the Detroit Lakes, Minnesota area. This RN supports quality review for Oasis and reviews plans of care. This position is ... facility. Must reside within driving distance of St. Mary's Medical Center in Detroit Lakes. No weekend, holiday, or...and emergency conditions. Specific duties in this position include quality review for Oasis and review… more
- UCLA Health (Los Angeles, CA)
- …including inspections of clinical areas, patient care practices, and administrative processes + Review medical records of services in preparation for health plan ... Description The Quality Management Nurse is responsible for...and safety. In this role, you will supports all Medical Group Health Education & Disease Management Programs utilizing… more
- The County of Los Angeles (Los Angeles, CA)
- …REQUIREMENTS: OPTION I:One year of experience performing the duties of a Utilization Review Nurse * or Medical Service Coordinator, CCS.** -OR- OPTION ... UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333)...needed, and to make recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review… more
- Veterans Affairs, Veterans Health Administration (Albuquerque, NM)
- …Patient Safety (QPS) Team! Responsibilities The Quality , Safety & Value (QSV) Peer Review Nurse Analyst completes and/or coordinates all aspects of the Peer ... VA Health Care System is looking for a Registered Nurse - Peer Review - Quality...Medical Center's improvement methodology and framework, and external review standards. Identifies when the review identifies… more
- State of Connecticut, Department of Administrative Services (New Haven, CT)
- …+ Conducts various types of case reviews for quality and appropriate medical management, cost containment, peer review and rehabilitation; + Summarizes and ... Utilization Review Nurse (40 Hour) Office/On-Site Recruitment...third-party administrator files to oversee contractor handling; + May review medical records of various health care… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical ...Determines need for and conducts in-service training to improve quality of admission and continued stay reviews, and to… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical ...necessary to resolve progression-of-care barriers through appropriate administrative and medical channels. ** QUALITY /SAFETY ESSENTIAL FUNCTIONS** + Participates… more
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- …the interdisciplinary team. Responsibilities Duties include but not limited to: Utilization Review (UR) Registered Nurse (RN) is responsible for providing ... care. The UR RN addresses psychosocial, as well as nursing and medical needs of patients and their families/caregivers, through participation in interdisciplinary… more
- CDPHP (Albany, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... coordinating with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care initial… more
- Lompoc Valley Medical Center (Lompoc, CA)
- …and peer review . The QA nurse supports concurrent oversight and review of clinical quality measures and evidence based standards of care for the ... supervisor of Quality /Risk and Infection Control. The Quality Assurance (QA) nurse supports the ...follow through with high degree of accuracy. Able to review medical records with an understanding of… more
- Actalent (Sunrise, FL)
- …patient satisfaction, safety, and appropriate length of stay. Responsibilities + Review prior authorization requests for medical necessity and appropriateness ... Actalent is hiring a Utilization Management Nurse ! Job Description The Utilization Management Nurse...standardized Review Criteria. + Coordinate with the Medical Director/Physicians for requests outside standard Review … more
- Centene Corporation (Little Rock, AR)
- …offering competitive benefits including a fresh perspective on workplace flexibility. Clinical Review Nurse - Concurrent Review & Outpatient Services ... 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national...overall health and appropriate level of care + Reviews quality and continuity of care by reviewing acuity level,… more
- Staffing Solutions Organization (Augusta, ME)
- …which is a reflection of our clients and the people they serve. **Registered Nurse - Authorization Review Unit - MaineCare in Augusta, ME** **Position Duties:** ... + Manage medical Prior Authorizations (PA) as assigned by the PA...by the PA supervisor, utilizing PA software tools; + Review and authorize provider requests for the following services… more
- Houston Methodist (Houston, TX)
- …by supporting multiple areas across the Organization. The Quality Resource Nurse position will oversee and routinely review clinical support practices to ... At Houston Methodist, the Quality Resource Nurse position is responsible...active listening and facilitating teamwork. + Partners with staff, medical staff, and clinical leadership to ensure excellence in… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, evidence-based guidelines, insurance ... guidelines to determine the appropriate level of care and the medical necessity of continued hospitalization. Secures initial payer authorization and continued… more
- Centene Corporation (New York, NY)
- …contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of ... to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members + Provides feedback… more
- AmeriHealth Caritas (LA)
- …with medical policies. When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical ... document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, and… more
- AmeriHealth Caritas (Washington, DC)
- …with medical policies. When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical ... document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, and… more
- US Tech Solutions (Columbia, SC)
- …resources to promote quality , cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate ... review determinations. Identifies and makes referrals to appropriate staff ( Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care… more
Related Job Searches:
Medical,
Medical Nurse,
Nurse,
Quality,
Quality Review,
Quality Review Nurse,
Review,
Review Nurse