- Veterans Affairs, Veterans Health Administration (Madison, WI)
- …of the agency through investigations/audits of patient care records. Responsibilities The Peer Review Registered Nurse Uses current trends and relevant theory to ... Assist in developing and implementing strategies to improve compliance with external /internal accrediting bodies and the risk management/peer review programs… more
- LA Care Health Plan (Los Angeles, CA)
- Medical Review Nurse Coder RN III (Payment...Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and ... safety net required to achieve that purpose. Job Summary The Payment Integrity Nurse Coder RN III is responsible for investigating, reviewing, and providing clinical… 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 ... 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
- 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 necessity and level of care using...relationships with patients, families, interdisciplinary team members, payers, and external case managers; listens and responds to the ideas… more
- Medical Mutual of Ohio (OH)
- …stay and level of care. + Extrapolates and summarizes medical information for physician review or other external review . + Generates appropriate written ... pre-employment substance abuse and nicotine testing._ **Title:** _Clinical Appeal & Claim Review Nurse II_ **Location:** _Ohio_ **Requisition ID:** _2500127_ more
- Actalent (Sunrise, FL)
- Actalent is hiring a Utilization Management Nurse !Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization ... staff to direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, utilizing… 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
- Albany Medical Center (Albany, NY)
- …America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients. * Completes ... Utilization Management and Quality Screening for assigned patients.* Applies MCG criteria to monitor appropriateness of admissions and continued stays, and documents… more
- US Tech Solutions (May, OK)
- …development and ongoing implementation of QM Work Plan activities. . Improve quality products and services, by using measurement and analysis to process, evaluate ... to meet QM objectives Responsibilities: . Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations.… more
- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review SpecialistJob Description The Behavioral Health Utilization Review Specialist conducts comprehensive utilization ... of psychiatric and chemical dependency services, and engaging in concurrent review with hospitals and mental health centers. The specialist is responsible… more
- Humana (Richmond, VA)
- …health first** Humana Healthy Horizons in Virginia is looking for a Quality Compliance Nurse Professional 2 (Maternal-Child Health/EPSDT) who will collaborate ... the promotion of family planning services and preventive health strategies. The Quality Compliance Nurse Professional 2 (Maternal-Child Health/EPSDT) works to… more
- ChildServe (Johnston, IA)
- Quality Assurance Registered Nurse (Full-Time) Nursing, Respiratory Therapy, and Supports Johnston, Iowa Apply Description The Quality Assurance Nurse ... practices Collaboration + Partner with interdisciplinary team members, leadership, and external stakeholders to address quality concerns + Support facility-wide… more
- Banner Health (AZ)
- …5. Identifies potential risk management FWA and Compliance issues during process of quality review for referral to the Risk Management and other appropriate ... remote and hybrid opportunities. As a Health Plan Registered Nurse RN Behavioral Health Quality of Care,...Health Plan members that have been referred to the Quality Management Department for review and resolution.… more
- Dartmouth Health (Lebanon, NH)
- …Surgical Services Quality in the vital work of clinical data review and analysis as well as direct participation in implementing improvement within Surgical ... to the Sr Director, Value Institute and the Vice Chair, Surgical Services Quality . The role serves as an internal consultant and partner for clinical service… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …a sound understanding about the care of a particular patient population. + Chart review and data abstraction in support of quality measurement, analysis, and ... quality improvement, accreditation standards, internal process improvements and external regulatory requirements Assist in achieving goals of high quality… more
- Bon Secours Mercy Health (Newport News, VA)
- …accreditation, and certification surveys in successful completion. + Prepares and submits quality reports as required by external agencies and payors.Facilitates ... improvement committees and projects as needed. + Supports Medical Staff Quality and Peer Review . + Promotes practices that detect, mitigate or prevent harm using… more
- University of Michigan (Ann Arbor, MI)
- Advanced Practice Professional ( Nurse Practitioner) Division of Hospital Medicine Apply Now **How to Apply** This is an Advanced Practice Professional (APP) job ... at the forefront of cutting-edge health sciences, health systems research, and quality improvement initiatives, with a growing portfolio of research funding. We take… more
- Fresenius Medical Center (New York, NY)
- …with the Medical Director and the Clinical Coordinator /Charge Nurse or Nurse Supervisor regarding the provision of quality patient care in the dialysis ... /Charge RN or Nurse Supervisor and Medical Director to implement FMS quality goals and develop facility specific action plans in order to achieve FMS … more
- Emory Healthcare/Emory University (Atlanta, GA)
- …and leadership programs + And more **Description** We're seeking a **Clinical Quality Coordinator (Registered Nurse / RN).** responsible for providing clinical ... Designing data collection plans for KPIs Integrate data from internal and external electronic systems + Using statistical and visualization methods + Identifying and… more
- Stanford Health Care (Palo Alto, CA)
- …growth and development of their APPs. Also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered ... fall in three categories: Clinical Oversight and Leadership; Administration; and Internal/ External Legal/Regulatory Issues. The Lead APP must supervise a minimum of… more
Related Job Searches:
External,
Nurse,
Quality,
Quality Review,
Quality Review Nurse,
Review,
Review Nurse