- 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
- 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
- State of Georgia (Thomas County, GA)
- Registered Nurse (Regional Quality Review (RQR)) - Region 4 Georgia - Thomas - Thomasville ... for DBHDD is located in downtown Atlanta. Job Description Job Title: Registered Nurse ( Regional Quality Review (RQR) ) - Region 4 (Thomasville, GA Area) Pay… 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
- Commonwealth of Pennsylvania (PA)
- …performing this Work Behavior as a charge nurse , head nurse , utilization review nurse , quality assurance nurse , or an industrial, employee or ... this Work Behavior as a charge nurse , head nurse , utilization review nurse , quality assurance nurse , or an industrial, employee or public health… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 241106-5613FP-001 Location East Hartford, CT Date Opened 11/7/2024 12:00:00 AM Salary ... - is accepting applications for a full-time Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=) position, located… 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
- Hackensack Meridian Health (Little Falls, 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 ... The VHSNJ multidisciplinary clinical and support teams provide high quality care to patients where they most want to...Hospice, and other clinical assessment tools as needed. + Review every Medicare and Managed Medicare admission chart to… more
- Premier Health (Troy, OH)
- …the patient experience with daily nurse leader rounding and executing quality actions plans. The **Utilization Review RN** manages the nursing care ... Position: ASSOCIATE NURSE MGR/ UTILIZATION REVIEW RN Dept:...the dynamic healthcare environment. Employee engagement, patient experience and quality outcomes are priorities for the ANM-Inpatient, who supports… more
- Hackensack Meridian Health (Brick, 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
- InnovaCare (San Juan, PR)
- …to the business. MMM Holdings, Inc.Job Description Inpatient Unit POSITION: Concurrent Review Nurse (CRN) POSITION DESCRIPTION Manages the inpatient utilization ... and confers daily regarding patient and physician related issues.8. Performs concurrent quality review and reports identified quality issues to the health… more
- CommonSpirit Health Mountain Region (Durango, CO)
- …and leaders who care about your success. Assist with training and coordinating clinical review and quality assurance. Lead and review the appropriateness of ... clinical care and documentation practices related to patients/residents. Review and evaluate quality data to determine...of the home health and/or hospice patient. + Registered Nurse + Valid CO Driver's License. + BLS Sedentary… 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
- Mohawk Valley Health System (Utica, NY)
- Registered Nurse - Utilization Review Nurse - Full Time - Days Department: CASE MANAGEMENT Job Summary Reports to and is under direct supervision of Case ... with case management and discharge planning. + Ensure compliance with quality patient care and regulatory compliance. Education/Experience Requirements Required: +… more
- Trinity Health (Springfield, MA)
- …Shift **Description:** Requires BSN At **Mercy Medical Center** the **Utilization Review /Appeals & Denials** **RN** performs utilization review with payers, ... determinations using screening criteria, and assists the physician, bedside Registered Nurse , ICC and Social Worker with utilization management and clinical… 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 (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
- 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
- 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
- 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
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