- Medical Mutual of Ohio (OH)
- … Medicare Supplement, and individual plans. Under limited supervision, the Medicare Nurse Reviewer applies medical necessity guidelines in making ... mind to more than 1.2 million members through our high- quality health, life, disability, dental, vision and indemnity plans....looking for applicants that have a strong clinical utilization management background. Medicare experience is a plus.… more
- CommuniCare Health Services Corporate (Indianapolis, IN)
- Medicare Biller The CommuniCare Family of Companies currently owns/manages over 130 World-Class Nursing and Rehabilitation Centers, Specialty Care Centers, and ... and Maryland. Since 1984, CommuniCare Health Services has provided superior, comprehensive management services for the development and management of adult living… more
- Medical Mutual of Ohio (OH)
- …provide peace of mind to more than 1.2 million members through our high- quality health, life, disability, dental, vision and indemnity plans. We offer fully insured ... and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Working under general supervision,… more
- AmeriHealth Caritas (Newtown Square, PA)
- …or BH equivalent advanced licensure. 5+ years of exp in case and utilization management Medicare program design and implementation. Your career starts now. We're ... us at www.amerihealthcaritas.com. **Responsibilities:** In conjunction with the Vice President of Medicare Care Management and the Chief Medical Officer, the… more
- Molina Healthcare (Long Beach, CA)
- …(QIA) in collaboration with the clinical lead, the medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA ... + Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality , cost-efficiency, and… more
- Medical Mutual of Ohio (OH)
- …provide peace of mind to more than 1.2 million members through our high- quality health, life, disability, dental, vision and indemnity plans. We offer fully insured ... and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Under general supervision,**… more
- Molina Healthcare (Spartanburg, SC)
- …Degree in Nursing preferred. **Required Experience** 1-3 years in case management , disease management , managed care or medical or behavioral health settings. ... or locality with reliable transportation. **Preferred Education** Bachelor's Degree in Nursing **Preferred Experience** 3-5 years in case management , disease… more
- The Cigna Group (Bloomfield, CT)
- This position, the Nurse Case Manager Senior Analyst, through the case management process, will promote the improvement of health outcomes to members and assist ... to professional practice within scope of licensure and certification quality assurance standards and all case management ...of direct clinical care to the consumer + Case Management exp strongly preferred + Medicare experience… more
- BrightSpring Health Services (Martinsburg, WV)
- …team of passionate and caring clinicians who make a difference in people's lives. Our nursing group focuses on compassion and meeting the needs of our clients in a ... services/training programs on a routine basis in cooperation with Operations management ; monitoring both skilled and non-skilled healthcare services + Directly… more
- Indian Health Service (Red Lake, MN)
- … Nursing Education (external link), Council on Accreditation of Nurse Anesthesia Educational Programs (external link), Accreditation Commission for Midwifery ... oversight and leadership of hospital accreditation readiness activities, manage the quality assurance and performance improvement program, and ensure the highest… more
- Northwell Health (New York, NY)
- **Req Number** 137365 Coordinates and implements the Quality Management /Performance Improvement Program at the facility. + Conducts education on quality ... management and performance improvement theoretical frameworks to promote high quality patient care. + Assists in developing appropriate measurements to assess… more
- Fairview Health Services (Edina, MN)
- …industry **License/Certification/Registration** Minnesota Board of Nursing Public Health Nurse license Certification in case management , gerontological ... not limited to: assessment, care planning, service coordination and referral, transition management , utilization management and quality assurance. The care… more
- CareFirst (Baltimore, MD)
- …with other business units: Utilization Management , Case Management , Claims, Quality Management and Compliance. The Nurse , Quality Review ... **Resp & Qualifications** **PURPOSE:** The role of the Quality Review Nurse (RN) is to...State Licensure Upon Hire Required. **Experience:** 5 years Clinical nursing experience. 3 years quality auditing and… more
- CVS Health (Phoenix, AZ)
- …care more personal, convenient and affordable. **Position Summary** This is a fulltime Quality Management Nurse Consultant opportunity within Arizona. The ... 60 miles) about 25-50% of the time. The QM Nurse Consultant is a work at home role. Experienced...limited to member services, provider relations and integrated care management ) to achieve the common goal of improving member… more
- CVS Health (Tallahassee, FL)
- …personal, convenient and affordable. **Position Summary** This is a full-time remote Quality Management Nurse Consultant opportunity. Working schedule is ... work outside of business hours, as needed. This position reports to the Potential Quality of Care (PQOC) nurse investigator team manager. This position is… more
- Fairview Health Services (Maplewood, MN)
- …+ **License/Certification/Registration** + Minnesota Board of Nursing Public Health Nurse license + Certification in case management , gerontological ... to: assessment, care planning, service coordination and referral, transition management , utilization management and quality ...+ Three to five years of experience in geriatric nursing , public health or care coordination/case management .… more
- Aveanna (Atlantic, IA)
- …and documenting skilled nursing care, under the supervision of a Registered Nurse , in accordance with the developed care plan and physicians orders for each ... Private Duty Nurse (LPN) ApplyRefer a FriendBack Job Details Requisition...Details Requisition #: 194191 Location: Atlantic, IA 50022 Category: Nursing Salary: Starting at $25.00 per hour Position Details… more
- State of Colorado (Pueblo, CO)
- …to and references the professional codes of conduct, regulatory agency standards, the Nurse Practice Act, State Board of Nursing , professional codes of ethics, ... Job Duties: + responsible for the direction, supervision and management of all Nursing staff of the...Rights Minimum Qualifications: Current, valid licensure as a Registered Nurse from the Colorado Board of Nursing … more
- UCLA Health (Los Angeles, CA)
- Description As the Utilization Management & Quality Review Nurse , you will be responsible for: + Ensuring appropriate, cost-effective, and high- quality ... California RN license, required * Two or more years of experience in utilization management , preferably in Medicare Advantage or managed care * Knowledge of … more
- Gentiva (Southern Pines, NC)
- …to give people the care they need with dignity, grace, and love. The ** Nurse Practitioner - Advanced Illness Management AIM) CPOM** facilitates advanced illness ... Quality Measures collection, documentation and reporting. **About You** ** Nurse Practitioner Requirements:** **Specialized Knowledge/Skills:** + Excellent leadership, interpersonal,… more
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