- CDPHP (Albany, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... physician-founded, member-focused, and community-based not-for-profit health plan that offers high- quality affordable health insurance to members throughout New York.… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical necessity and level of care using...relationships with patients, families, interdisciplinary team members, payers, and external case managers; listens and responds to the ideas… more
- Actalent (Sunrise, FL)
- Actalent is hiring a Utilization Management Nurse ! Job Description The Utilization Management Nurse (UMN) collaborates closely with the interdisciplinary team to ... in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care, ensuring smooth… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse !Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization requests to ensure ... staff to direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, utilizing… more
- Veterans Affairs, Veterans Health Administration (Fort Harrison, MT)
- Summary The Registered Nurse (RN) Chief Quality and Patient Safety executes leadership that is characterized by substantial and continuous responsibility and ... have systems and processes in place to provide safe, quality care that is consistent with external ...Joint Patient Safety Reporting (JPSR), Tort Claims, and Peer Review . Responsible for completing clinical quality reviews,… 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
- 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
- Lompoc Valley Medical Center (Lompoc, CA)
- …and peer review . The QA nurse supports concurrent oversight and review of clinical quality measures and evidence based standards of care for the ... supervisor of Quality /Risk and Infection Control. The Quality Assurance (QA) nurse supports the ...improvement goals/priorities and in leading improvement efforts related to Quality /Peer Review . + Collaborate with external… more
- CVS Health (Annapolis, MD)
- …of services. + Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management ... programs and facilitates referral + Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization **Required… more
- UHS (Binghamton, NY)
- Position OverviewUnited Health Services (UHS) is seeking a Quality Management Nurse Analyst to support our commitment to excellence in patient care and safety. ... In this analytical and clinically focused role, you will review clinical data, monitor quality metrics, and...agencies and organizational policies. Tracks Plans of Correction to external agencies to ensure follow up and compliance with… more
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