- UNIVERSITY HEALTH (San Antonio, TX)
- …Information Technician (RHIT), Registered Health Information Administrator (RHIA), and/or Registered Nurse (s) ( RN ) are highly preferred. recblid ... Assurance (NCQA) that promotes Healthcare Effectiveness Data and Information Set ( HEDIS ) metrics, Utilization Review Accreditation Commission (URAC), and the… more
- Ventura County (Ventura, CA)
- …CNA_MOA_2023-2028.pdf (ventura.org) (https://vcportal.ventura.org/CEO/HR/MOA/docs/CNA\_MOA\_2023-2028.pdf) PAYROLL TITLE: Senior Registered Nurse - Ambulatory ... Care DISTINGUISHING CHARACTERISTICS: The Senior Registered Nurse -Ambulatory Care series is distinguished from other nursing classifications in that they are… more
- Community Health Systems (Naples, FL)
- Join us as a ** Registered Nurse ( RN ) - Utilization Review position** at Physicians Regional Collier Unit: Utilization Review Shift: Mon-Fri (this is ... for Full and Part-Time roles **Job Summary** The Utilization Review Nurse - RN reviews...patient-centered service and continuous improvement. **Licenses and Certifications** + RN - Registered Nurse -… 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...staff meetings and huddles as appropriate. + Participates in Hedis , GPRO, and other quality programs as needed +… 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 and ... facilitate appropriate Health Education opportunities. Additionally, you will performs HEDIS related activities, Pay for Performance activities, Provider Access and… more
- Actalent (Santa Barbara, CA)
- …+ Experience with HEDIS medical record abstraction. Additional Skills & Qualifications + Registered Nurse ( RN ) license. + Bilingual skills in Spanish may ... Job Title: Health Plan Nurse CoordinatorJob Description The Health Plan Nurse Coordinator is a Registered Nurse assigned to various Health Services… more
- University of Southern California (Alhambra, CA)
- …InterQual guidelines, and Medicaid/Medicare contracts and benefit systems. Required Licenses/Certifications: + Req Registered Nurse - RN (CA DCA) + Req Basic ... major duties of the Case Manager overlap into inpatient duties including: Concurrent review of all patients to validate that the appropriate patient status is… 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. + Minimum… more
- Banner Health (AZ)
- …employment settings by including remote and hybrid opportunities. As a **Licensed Practical Nurse (LPN)** for **Banner Health Plans** , you will be an integral part ... Management Team** . This assignment-based role focuses on independent chart review and clinical assessment. **Key Responsibilities** : + Independently review… more
- Fallon Health (Worcester, MA)
- …care related field preferred. **License** : Active, unrestricted license as a Registered Nurse in Massachusetts **Certification** : Certification in Case ... and reliable transportation **Experience:** * 1+ years of clinical experience as a Registered Nurse managing chronically ill members or experience in a… more
- Molina Healthcare (Tucson, AZ)
- …quality investigations, preferably in a managed care setting, or equivalent experience * Registered Nurse . License must be active and unrestricted in state of ... initiation and management of interventions (eg, improving patient safety); preparation and review of potential quality of care and critical incident cases; review… more
- Centene Corporation (Topeka, KS)
- …Licensed Marital and Family Therapist (LMFT), Licensed Certified Social Worker (LCSW), Licensed Registered Nurse ( RN ), Acute Care Nurse Practitioner ... field or equivalent work experience within a managed care environment related to HEDIS record review , quality improvement, medical coding or transferable skill… 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
- Molina Healthcare (Madison, WI)
- …or equivalent combination of relevant education and experience. * Advanced Practice Registered Nurse (APRN) license. License must be active and unrestricted ... the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review and manages the… more
- Insight Global (Austin, TX)
- …* 1+ yr in care management/ HEDIS /Stars, women's health, or imaging navigation * Active Registered Nurse ( RN ) Compact License and RN License in one ... new program that reviews health risk assessments and supports HEDIS gap closure. In this role, you will conduct...* Minimum of 2+ years' experience working as a Registered Nurse , * 1+ year of experience… more
- CareFirst (Baltimore, MD)
- …are subject to change based on evolving business needs. **Licenses/Certifications** : Health Services\ RN - Registered Nurse - State Licensure and/or Compact ... activities of Onsite Care Management staff, Onsite Clinical Navigators and/or other Registered Nursing roles embedded at a partnering hospital. This role will assist… more
- Centene Corporation (Maumee, OH)
- …insurance experience required; 1+ year quality experience preferred. **License/Certification:** Registered Nurse , Licensed Practical Nurse , Licensed ... states, and have a (2) combination of experience in the following areas: HEDIS , managed care, quality, process improvement/ project management (such as lean, CPHQ,… more
- University of Miami (Miami, FL)
- …Providers supervises advance d practice providers (APPs) ( ie, Advanced Registered Nurse Practitioners, Physician Assistants etc.). Key responsibilities of ... Medicare annual wellness exam documentation preferred + Knowledge of HEDIS Quality Care Gaps - review and...Knowledge of HEDIS Quality Care Gaps - review and closure preferred + Knowledge of Hierarchical Condition… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Quality (CPHQ) or Certification in Health Care Quality and Manager (CHQM) * Registered Nurse Compensation and Benefits: Pay Range: $88,600.00 - $117,400.00 - ... subject matter experts on coding accuracy and Quality programs such as including HEDIS and Stars. Your Responsibilities As part of a Blue Cross provider-performance… more
- CDPHP (Latham, NY)
- …varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, ... for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources.… more
