- AdventHealth (Orlando, FL)
- …home health + 2 years of experience in management position. + Registered Nurse State Licensure and/or Compact State Licensure + Cert for Oasis Specialist-Clinical ... (COSC) **Preferred qualifications:** + 2 years Leadership Experience + 3 years of Work Experience This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range… 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 ... involves evaluation clinical practices, identifying areas for improvement, and implementing quality improvement initiatives to enhance patient care and safety. In… more
- Penn State Health (Reading, PA)
- …veteran status, and family medical or genetic information._ **Position** RN Registered Nurse Patient Safety/Peer Review /Mortality - Quality Services ... improve reliability of systems. Accountable for medical staff peer review coordination to support medical staff clinical quality...required + Currently licensed to practice as a registered nurse by state of employment or holds a multistate… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE ... regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team....Determines need for and conducts in-service training to improve quality of admission and continued stay reviews, and to… more
- Houston Methodist (Houston, TX)
- …This position has achieved an expert level at all objectives delineated in the Utilization Review Nurse and Utilization Review Specialist Nurse job roles ... At Houston Methodist, the Sr Utilization Review Specialist Nurse (URSN) position is...team. The Sr URSN position promotes and maintains compassionate quality of care through collaboration with all service team… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the ... guidelines and evidence-based practice * Quality of Practice*: * Promotes quality through evidence-based utilization review processes and actively contributes… 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 ... administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the largest… more
- CDPHP (Latham, 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 ... physician-founded, member-focused, and community-based not-for-profit health plan that offers high- quality affordable health insurance to members throughout New York.… more
- Zurich NA (Schaumburg, IL)
- Medical Bill Review Senior Nurse 127127 Zurich Insurance is currently looking for a **Medical Bill Review Senior Nurse ** to work from our Schaumburg, IL ... to customer inquiries quickly, accurately and in a professional manner. + Meet quality standards by adhering to Best Practices and participating in monthly peer … more
- Actalent (Porterville, CA)
- Remote Concurrent Review Nurse Job Description We are seeking a dedicated Concurrent Review Nurse to perform concurrent reviews, assess members' overall ... and facilities + Productivity 17-20 reviews a day and quality expectations must be met + Partners with interdepartmental...projects within utilization management as part of the clinical review team + Partners and works with Medical Affairs… more
- Medical Mutual of Ohio (OH)
- …pre-employment substance abuse and nicotine testing._ **Title:** _Clinical Appeal & Claim Review Nurse II_ **Location:** _Ohio_ **Requisition ID:** _2500127_ ... mind to more than 1.2 million members through our high- quality health, life, disability, dental, vision and indemnity plans....care. + Extrapolates and summarizes medical information for physician review or other external review . + Generates… more
- Centene Corporation (New York, NY)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review ... and competent manner. Processes all prior authorizations to completion utilizing appropriate review criteria. Identifies and refers all potential quality issues… 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 ... This position will participate in ongoing professional development activities, quality improvement, and continuing education activities. This role Improves… more
- US Tech Solutions (Chicago, IL)
- …experience with Utilization Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions is a global staff ... development and ongoing implementation of QM Work Plan activities. + Improve quality products and services, by using measurement and analysis to process, evaluate… more
- New York State Civil Service (New York, NY)
- NY HELP Yes Agency Mental Health, Office of Title Registered Nurse 1 Psychiatric (NY HELPS), New York State Psychiatric Institute, Utilization review , P26749 ... Zip Code 10032 Duties Description The selected candidate will provide Utilization Review services, including but not limited to conducting daily Utilization … more
- CVS Health (Salt Lake City, UT)
- …to meet quality and metric expectations. **Required Qualifications** + Registered Nurse (RN) - active license. + 3+ Years of clinical experience. + 1+ ... a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and plan language… more
- HonorHealth (AZ)
- …3,700 affiliated providers and close to 2,000 volunteers dedicated to providing high quality care, HonorHealth strives to go beyond the expectations of a traditional ... Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of health care services… more
- Centene Corporation (Sacramento, CA)
- …current CA license.** **Must have** **5-7 years related** **experience in UM-Concurrent Review . 2+ years of acute care experience required. 10% Travel required.** ... projects within utilization management as part of the clinical review team + Partners and works with Medical Affairs...education to providers on utilization processes to ensure high quality appropriate care to members + Partners with leadership… more
- Centene Corporation (New York, NY)
- …benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care. + Performs medical necessity ... criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care +… more
- Centene Corporation (Olympia, WA)
- …setting to determine overall health and appropriate level of care + Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of ... discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in… more