- State of Maine, Bureau of Human Resources (Augusta, ME)
- MaineCare Quality Review Nurse Augusta , Maine , United States | Nursing | Full-time Apply by: Jan. 22, 2025 Apply with Linkedin Apply Department of Health ... yes and you are licensed as a Registered Professional Nurse in the State of Maine, as issued by...your personal vehicle for work purposes. Minimum Qualifications: Registered Nurse and three (3) years of progressively responsible experience… 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 ... plan policies and regulatory guidelines + Identifying and reporting Potential Quality Issues (PQI) and supporting Provider Dispute Resolution (PDR) processes to… more
- HCA Healthcare (Corpus Christi, TX)
- …Corpus Christi Medical Center Bay Area!** **Job Summary and Qualifications** **The Quality Review Nurse position encompasses multiple responsibilities ... assigned functions and/or reviews, as delegated by the Administrative Quality /PS/RM Director.** **This position is a M-F, 34 hours...path, we encourage you to apply for our Registered Nurse Clinical Reviewer PRN opening. We review … more
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- Utilization Review Nurse (40 Hour) Office/On-site Recruitment # 250102-5612FP-001 Location Hartford, CT Date Opened 1/6/2025 12:00:00 AM Salary $78,480 - ... Addiction Services ( DMHAS (https://portal.ct.gov/DMHAS/About-DMHAS/Agency/About-DMHAS) ) as a Utilization Review Nurse (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5612FP&R1=&R3=) ! Bring your skills… 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
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ensuring the ... receipt of high quality , cost efficient medical outcomes for those enrollees with...authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies… more
- Hackensack Meridian Health (Wall, NJ)
- …and follow up. + Review all new admission charts to ensure all quality indicators are completed at the initial encounter with the patient or within the five ... coding, OASIS and Hospice, and other clinical assessment tools as needed. + Review every Medicare and Managed Medicare admission chart to determine that the coding… more
- Community Health Network (Indianapolis, IN)
- Registered Nurse (RN) Case Manager/ Utilization Review - North Emergency Job Ref 2408203 Category Nursing Job Family Case Manager Department Case Management ... **Make a Difference** Community North has a part-time RN Case Manager/Utilization Review position available in the Emergency Department. The Registered Nurse … 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
- HCA Healthcare (Webster, TX)
- …learn! **Job Summary and Qualifications** We are seeking a RN Clinical Reviewer in Quality Management for our facility to ensure that we continue to provide all ... patients with high quality , efficient care. We are an amazing team that...+ Bachelor's Degree in Nursing required. + Current Registered Nurse License in the State of Texas or Multi-State… more
- Glens Falls Hospital (Glens Falls, NY)
- …can be foundhere. **Job:** **Nursing - Case Management* **Title:** *RN - Utilization Review Nurse * **Location:** *NY-Glens Falls* **Requisition ID:** *2410V* ... and interdisciplinary team to support the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of… 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
- 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
- US Tech Solutions (May, OK)
- …development and ongoing implementation of QM Work Plan activities. . Improve quality products and services, by using measurement and analysis to process, evaluate ... to meet QM objectives Responsibilities: . Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations.… more
- Catholic Health Initiatives (Little Rock, AR)
- **Overview** As a Utilization Review nurse with CHI St Vincent Little Rock, you'll work with physicians, other registered nurses, specialized departments, and ... a 600 bed faith-based, non-profit, acute care facility providing quality health care to patients and communities from all...and tracts Medicare denials, works with medical records to review third party payor denials. + Works with other… more
- Veterans Affairs, Veterans Health Administration (Tampa, FL)
- …James A Haley Veterans Hospital and Clinics has a Registered Nurse Quality Management consultant for the External Peer Review Program (EPRP). Quality ... growth and development in practice with increased levels of self-direction in quality -of-care outcomes. Responsibilities Duties listed but are not limited to: The QM… more
- Veterans Affairs, Veterans Health Administration (Wilmington, NC)
- Summary The Quality Nurse is accountable to the Assistant Chief, Quality & Safety. The Quality Nurse is a registered professional nurse , ... regulatory activities.- Healthcare Effectiveness Data and Information Set (HEDIS) Measures The Quality Nurse is also responsible and accountable for performing… more
- Molina Healthcare (AZ)
- …initiation and management of interventions (eg, improving patient safety); preparation and review of potential quality of care and critical incident cases; ... management functions, including quality monitoring audits, credentialing and recredentialing, quality of care concerns, and peer review . * Is well-versed in… more
- HCA Healthcare (Derry, NH)
- …set us apart from any other healthcare provider. We are seeking a(an) Registered Nurse RN Clinical Quality Lead to join our healthcare family. **Benefits** ... and empowers their passion for patient care. Apply today for our Registered Nurse RN Clinical Quality Lead opportunity. **Job Summary and Qualifications**… more
- Intermountain Health (Las Vegas, NV)
- **Job Description:** The LPN, under the direction of a registered nurse , licensed physician, or other specified health care professional, participates in patient ... + Demonstrates responsibility and accountability for own practice. + Participates in quality improvement projects and initiatives. + May act as a lead, mentor,… more
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