- Veterans Affairs, Veterans Health Administration (Orlando, FL)
- …process management for Quality Management. Responsibilities The Peer Review Quality Management Specialist RN is a proficient nurse who understands a ... Summary The Registered Nurse Peer Review QM Specialist at...accreditation standards, knowledge of applicable standards and directives, peer review and quality data for individual profiles,… 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 ... involves evaluation clinical practices, identifying areas for improvement, and implementing quality improvement initiatives to enhance patient care and safety. In… more
- HCA Healthcare (Richmond, VA)
- …we encourage you to apply for our Operating Room Quality Clinical Nurse Coordinator opening. We review all applications. Qualified candidates will be ... **Introduction** Do you have the career opportunities as a(an) Operating Room Quality Clinical Nurse Coordinator you want in your current role? We invest in what… 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
- 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 ... Summary Peer review is a protected program that identifies potential...and promote a program to improve outcomes. Evaluates the quality and appropriateness of patient care using established criteria.… 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
- 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...resolve progression-of-care barriers through appropriate administrative and medical channels. ** QUALITY /SAFETY ESSENTIAL FUNCTIONS** + Participates in quality … more
- Elevance Health (Morgantown, WV)
- RN Utilization Management/ Review Nurse - InPatient Medicaid (JR155056) **Location:** This position requires you to **reside in the state of West Virginia.** ... integration. **Work Hours** : Monday through Friday, 8am - 5pm The **Medical Management Nurse ** (Medicaid Utilization Review ) is responsible for review of… 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
- Actalent (Columbus, OH)
- …+ Utilization management + Prior authorization + Utilization review + Clinical review + Patient care + Licensed registered nurse Additional Skills & ... collaboration with healthcare providers and the authorization team to ensure timely review and approval of services. Responsibilities + Perform medical necessity and… 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
- 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
- Actalent (Tampa, FL)
- Actalent is hiring a Clinical Review Nurse role! Job Description The Clinical Reviewer is a telephonic position responsible for recommending discharge plans, ... telephonic touch points with each facility point person to review each member within that facility and confirm appropriateness...quality and standards. + 3 years of concurrent review experience and/or discharge planning. + 2 years of… 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
- 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
- AmeriHealth Caritas (Washington, DC)
- …When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines to ... in decision-making. Productivity expectations include meeting established turnaround times, quality benchmarks, and efficiency metrics in a fast-paced environment.… more
- US Tech Solutions (Columbia, SC)
- … quality , cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and ... medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director,… more
Related Job Searches:
External Quality Review Nurse,
Nurse,
Performance Quality Review Nurse,
Quality,
Quality Nurse,
Quality Review,
Quality Review Nurse Medical,
Quality Review Nurse RN,
Review,
Review Nurse