- Insight Global (Philadelphia, PA)
- …patient's care needs. The HEDIS nurse focuses solely on using HEDIS measuring criteria to review health plans in accordance with healthcare facility ... Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ . Skills and Requirements Previous HEDIS review experience Active RN License… more
- Insight Global (Philadelphia, PA)
- …) Strong computer skills Ability to occasionally travel to local providers Previous HEDIS review experience or experience with Utilization Review , Quality, ... Description A client of Insight Globals is looking for HEDIS RNs or LPNs for a partially remote contract...of medical records assigned by a Clinical Quality Lead nurse . Miles will be reimbursed for any travel. Computer… more
- Community Health Systems (Naples, FL)
- …meet deadlines. + Effective written and verbal communication skills. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact ... **Job Summary** Under the direction of the UR Director/Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical condition… more
- Defense Health Agency (Oklahoma City, OK)
- **Overview** **Advanced Practice Registered Nurse , Tinker AFB, Oklahoma** Tinker AFB is located in Oklahoma City, Oklahoma. Oklahoma City offers all of the ... is permitted. Apply for this Job Online (https://careers-civilianmedicaljobs.icims.com/jobs/8586/advanced-practice- registered - nurse -%28family%29/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336268516) **Location** _US-OK-Oklahoma City_ **Job… more
- Hackensack Meridian Health (Tinton Falls, NJ)
- …in Nursing. **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License. **Licenses and Certifications Preferred:** + Professional ... to transform healthcare and serve as a leader of positive change. The ** RN , Community Based Care Management** provides direct support to physician practices and… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …Nurse ( RN ) licensure required + Registered Nurse ( RN ) licensure required + Supports quality improvement HEDIS measures and clinical quality ... related HEDIS record collection and measures improvement with analytical review /evaluation and / or Quality Improvement. Experience in data and chart reviews… 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...in staff meetings and huddles as appropriate. Participates in Hedis , GPRO, and other quality programs as needed Enters… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Registered Nurse Care Coordinator, Quality Management Full Time, 80 Hours Per Pay Period, Day Shift Occasional travel as needed Covenant Medical Group ... duties. + Provides care coordination services within the scope of practice as a registered nurse meeting all required standards both legal and regulatory. + In… more
- UCLA Health (Los Angeles, CA)
- Description The Quality Management Clinical Nurse Specialist is responsible for conducting comprehensive facility site reviews (FSRs) to ensure compliance with ... facilitate appropriate Health Education opportunities. Additionally, you will performs HEDIS related activities, Pay for Performance activities, Provider Access and… 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: May 12, 2025...Participate in quality assurance activities including meetings and peer review . + Ensure cooperation and coordination between Clinical Services… 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; or LMSW;… more
- Fallon Health (Worcester, MA)
- …care related field preferred. **License** : Active, unrestricted license as a Registered Nurse in Massachusetts **Certification** : Certification in Case ... Fallon Health Pharmacist, referring members in need of medication review based upon Program process o Develops and fosters...**Experience:** * 1+ years of clinical experience as a Registered Nurse managing chronically ill members or… more
- Fallon Health (Worcester, MA)
- …related field preferred **License/Certifications:** + Active, unrestricted license as a Registered Nurse in Massachusetts; current Driver's license and reliable ... providers and office staff and may lead care plan review with providers and care team as applicable +...**Experience:** + 1+ years of clinical experience as a Registered Nurse managing chronically ill members or… 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
- Adecco US, Inc. (Houston, TX)
- Adecco Healthcare & Life Sciences is assisting a client hire a Utilization Management Nurse in Houston, TX! This role is hybrid with a mix of work from home and in ... $85,00 to $110,000 yearly **Responsibilities of the Utilization Management Nurse :** . Responsible for the follow-up through for the...and institutes a care management plan . Provides concurrent review on members who are hospitalized at all levels… more
- Elevance Health (Wallingford, CT)
- **Wellness Nurse Consultant** **_$5000 Sign-on Bonus._** _Location: This position is primarily based in Connecticut, with occasional presentations in Maine, and New ... we will drive the future of health care. The **Wellness Nurse Consultant** position is responsible for developing and recommending customized, group-specific… more
- Centene Corporation (Tacoma, WA)
- …or Healthcare Administration required **Experience in Behavioral Healthcare field preferred:** Registered Nurse ( RN ) certification, Licensed Mental Health ... Care or Healthcare Administration required. Experience in Behavioral Healthcare field required. Registered Nurse ( RN ), Licensed Clinical Social Worker… more
- CareFirst (Baltimore, MD)
- …addition to the required work experience. **Licenses/Certifications Upon Hire Required:** Health Services\ RN - Registered Nurse Active State Licensure and/or ... (MCG) to act as a resource to conduct concurrent review for medical necessity and appropriate level of care...health care costs. We are looking for an experienced Registered Nurse and people leader with UM/CM… more
- University of Michigan (Ann Arbor, MI)
- …degree or diploma in Nursing and a Masters degree in Nursing. + Current licensure as a Registered Nurse in the state of Michigan. + Minimum of five (5) years ... professional nursing leadership and administrative direction for nursing practice for Registered Nurses, and, as indicated for Licensed Practical Nurses and… more
- Dignity Health (Bakersfield, CA)
- …special projects as assigned. **Qualifications** **Minimum Qualifications:** - CA Clinical licensure ( Registered Nurse ( RN ), Licensed Vocational Nurse ... clinical and non-clinical quality management staff. - 3 years HEDIS measures reporting and experience in CMS Stars, P4P,...Value Based Payment Programs. - 3 years Medical record review project management. - Bachelor's degree or equivalent in… more
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