- AmeriHealth Caritas (Philadelphia, PA)
- …; **Education/ Experience:;** + Bachelor's degree or equivalent relevant experience + Unrestricted Registered Nurse ( RN ) or Physical Therapist (PT) + Valid ... LTSS UM Department, including authorization and approval of services, appeals and the coordination of benefits for all LTSS...and development and to ensure staff's expertise. + Reviews quality audits and shares audit results in a timely… more
- Alameda Health System (Oakland, CA)
- …nursing background. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. Preferred ... as needed. In essence, they orchestrate efficient utilization management to deliver high- quality patient care. **DUTIES & ESSENTIAL JOB FUNCTIONS** : NOTE: Following… more
- Presbyterian Homes and Services (Roseville, MN)
- …communicate at IDT + Site specific education + Key measure management Qualifications + Registered nurse with current licensure from the State Board of Nursing in ... the VP of Clinical Services to improve the overall Quality Other specific areas of responsibility include but are...Auditing RUG grouper/MDS end splits + Reviewing all expedited appeals and ALJ level appeals + Monthly… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …participates in all WC State Reporting and audits. Essential Qualifications + Currently licensed Registered Nurse ( RN ), Nurse Practitioner (NP), or ... decision maker and catalyst for achieving corporate goals through delivery of quality driven, clinically effective and cost-effective services. This role will be… more
- Centene Corporation (Jefferson City, MO)
- …Social Worker (LCSW), Licensed Mental Health Counselor (LMHC), Licensed Professional Counselor (LPC), Registered Nurse ( RN ), or Licensed Practical Nurse ... + Develop and maintain the audit process and tools related to: authorizations, appeals , quality events, and case management in CCMS; interrater reliability… more
- Texas Health Resources (Bedford, TX)
- …management growth inclusive of supervisory and leadership experience Required Licenses and Certifications RN - Registered Nurse Upon Hire Required Or LMSW ... the DFW mid-cities. As a 322-bed, acute-care, full-service hospital, we provide high- quality , convenient care to residents of Hurst, Euless, Bedford, and the… more
- Brockton Hospital (Brockton, MA)
- …responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It is ... accrediting bodies. Works collaboratively with the multidisciplinary team to assure quality , timely and cost efficient care. Develops, implements and evaluates the… more
- Houston Methodist (Houston, TX)
- …leading multi-site or enterprise-level programs preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... oversight of the activities within the assigned functional area(s), ensuring quality , productivity, functional excellence, and efficiency to accomplish strategic and… more
- State of Colorado (Fremont County, CO)
- …work so required care is provided despite unexpected occurrences to provide quality nursing care. Safety + Monitor safety needs by supervising residents' ... whereabouts, interactions, and conditions and refer to the charge nurse if necessary Hygiene Care + Collaborate with the charge nurse and other nursing personnel… more
- State of Colorado (Garfield County, CO)
- …with others to ensure proper resident care and work completion. + Inform RN 's and LPN's of findings and changes in resident condition. + Maintains therapeutic ... CNA. Education and Work Experience Substitutions: + A valid nurse aide certification (CNA) from the Colorado Department of...work experience Conditions of Employment: + Current and Active RN License renewal required. + Must be willing to… more