- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The role of the Quality Review Nurse (RN) is to evaluate clinical quality and procedures within the Clinical ... Management, Case Management, Claims, Quality Management and Compliance. The Nurse , Quality Review position develops procedures and reinforce quality … more
- Rising Medical Solutions (Chicago, IL)
- …was born - and continues to thrive. Rising Medical Solutions is looking for a Nurse Auditor who wants to make their mark in the world of medical cost containment. ... team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule compliance,… more
- Providence (WA)
- …Nursing + Dual RN License: Oregon and Washington + 1+ years' experience in Quality Management, Quality Improvement, Utilization Review Auditing + 1+ years' ... HEDIS who will:** + Be responsible for conducting clinical quality audits for the Quality Department +...program evaluation, team facilitation, data analysis and or case review + Experience working as a Nurse … more
- AmeriHealth Caritas (Florence, SC)
- ** REMOTE | Care Manager II Registered Nurse (BSN) - Foster Care Program -SC** Location: Florence, SC Primary Job Function: Medical Management ID**: 34390 **Job ... Counties preferred are York, Florence, Darlington, Williamsburg and Horry. RN required. ** Remote to qualified candidates living in South Carolina with a preference… more
- aptihealth (Clifton Park, NY)
- …an affiliated medical group that makes it easier for people to access speedy high quality mental health care at the right place and right time. The technology and ... freedom in your work habits Your Role The Registered Nurse Case Manager team at AptiHealth is pivotal to...team within the AptiHealth Medical Group to provide high quality care to each AptiHealth patient. Responsibilities + Complete… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …Bon Secours Mercy Health, we are dedicated to continually improving health care quality , safety and cost effectiveness. Our hospitals, care sites and clinicians are ... Triage Specialist will maintain a performance standard that prioritizes safety, quality and experience and coincides with the organization's mission and identified… more
- Actalent (Austin, TX)
- Job Description * Lead data collection and abstraction for company quality measures, including HEDIS, CMS, and CHIPRA * Assess vendor-delegated abstraction ... activities and compare results to HEDIS standards and/or custom * Review medical records and abstract data for HEDIS and other measure sets * Track and report on… more
- Centene Corporation (Tallahassee, FL)
- …flexibility. **Must be a current Florida resident!!** **Centene is currently seeking a Clinical Review Nurse - Prior Authorization to join our team. This role ... management, and have a solid foundation in hands-on patient care.** **This position is Remote Work From Home. The Schedule will be** **Tuesday- Saturday 9am -6 pm or… more
- Veterans Affairs, Veterans Health Administration (Kings County, NY)
- …risk, and guides the organization through frequent interactions with other service chiefs. The Nurse IV Deputy Chief of Quality Management (QM) functions as an ... such as the Joint Patient Safety Reporting (JPSR), Tort Claims, and Peer Review . Responsible for completing clinical quality reviews, clinical data analysis, and… more
- Veterans Affairs, Veterans Health Administration (Coatesville, PA)
- …(Performance Measurement/Improvement, External Reviews/Accreditation, Risk Management/Peer Review Coordination, Infection Prevention, Patient Safety, Controlled ... quality activities (Performance Measurement/Improvement, External Reviews/Accreditation, Risk Management/Peer Review Coordination, Infection Prevention, Patient Safety, Controlled Substance Program).… more
- Centene Corporation (Madison, WI)
- …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
- Prime Therapeutics (Columbus, OH)
- …This position has managerial and clinical oversight of the Clinical Pharmacist and Registered Nurse Review Team, playing a key role in medical and pharmacy ... our passion and drives every decision we make. **Job Posting Title** Supervisor Clinical Pharmacist Review - Remote in California **Job Description Summary**… more
- System One (Baltimore, MD)
- …participating in internal audits for Supplemental Data, and supporting other needs within the Quality Department. Pay: $37/HR 90% Remote May need to go onsite in ... if errors are found. Correct errors identified through over-read process, including a re- review of charts that may contain similar errors. + Identify and report… more
- HCA Healthcare (Mcallen, TX)
- …Are you passionate about delivering patient-centered care? Submit your application for Registered Nurse Quality position and spend more time at the bedside with ... may vary by location._ **Job Summary and Qualifications** The Review Nurse Clinical Reviewer position encompasses multiple...assigned functions and/or reviews, as delegated by the Administrative Quality /PS/RM Director. This is NOT A REMOTE … more
- Magellan Health Services (Boise, ID)
- … quality of care. General Job Information Title Care Manager (SUD utilization review preferred) - REMOTE USA Grade 24 Work Experience - Required Clinical ... This role is 100% remote , preference to candidates that live in Idaho....in Idaho. Also interested in candidates with SUD utilization review experience. Under general supervision, and in collaboration with… more
- Molina Healthcare (Seattle, WA)
- …HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of ... Any of the following: Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse (LVN) or...social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of hospital… more
- State of Colorado (Denver, CO)
- Youth Corrections Medical Operations Coordinator ( Nurse V) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4573875) Apply Youth Corrections ... Medical Operations Coordinator ( Nurse V) Salary $108,540.00 - $151,968.00 Annually Location Denver...provides support for performance evaluations. This role also includes review and implementation of preventive health care services, program,… more
- Veterans Affairs, Veterans Health Administration (San Diego, CA)
- …care, include all healthcare specialties and are integrated into the Quality Management Service. Demonstrates knowledge of current concepts and principles of ... process improvement and external review standards. Analyzes and interprets data to determine the...other regulatory agency requirements. Initiates, leads, and/or participates in quality improvement activities to collect data, analyze results, to… more
- State of Michigan (Jackson, MI)
- Registered Nurse Manager 13 Print (https://www.governmentjobs.com/careers/michigan/jobs/newprint/2364011) Apply Registered Nurse Manager 13 Salary $40.18 - ... clinical supervisor of an inpatient unit. Responsibilities include participation in the review and development of nursing policies and procedures, approval of leaves… more
- Molina Healthcare (Bothell, WA)
- …HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of ... are seeking a candidate with WA State LICSW, LMHC, LMFT, or Psychiatric Nurse RN licensure. Candidates should be proficient with Microsoft Office products, ie Excel,… more