- New York State Civil Service (New York, NY)
- NY HELP Yes Agency Mental Health, Office of Title Registered Nurse 1 Psychiatric (NY HELPS), New York State Psychiatric Institute, Utilization review , P26749 ... Zip Code 10032 Duties Description The selected candidate will provide Utilization Review services, including but not limited to conducting daily Utilization … more
- Centene Corporation (New York, NY)
- …benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care. + Performs medical necessity ... criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care +… more
- Centene Corporation (Oklahoma City, OK)
- …setting to determine overall health and appropriate level of care + Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of ... discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in… more
- CVS Health (OH)
- …1993. We provide flexible, cost-effective care management solutions that promote high- quality healthcare for members. We are seeking a dedicated Utilization ... Management (UM) Nurse to join our remote team. **Position Summary** The...Lead is instrumental in onboarding new team members, monitoring quality , triaging assignments, and leading designated projects. Acting as… 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 (Indianapolis, IN)
- …VASQIP Consultant utilizes all aspects of the nursing process to provide optimal quality review of surgical care provided to patients undergoing operative ... Veterans Affairs Surgery Quality Improvement Program (VASQIP) Quality Consultant Registered Nurse (RN) demonstrates leadership,...all aspects of the nursing process to provide optimal quality review of surgical care provided to… more
- HCA Healthcare (Nashville, TN)
- …and Qualifications** The Quality Nurse Coordinator coordinates and facilitates Quality /Peer Review Committee in conjunction with the VP of Quality ... we encourage you to apply for our Quality Nurse Coordinator opening. We promptly review all applications. Highly qualified candidates will be contacted for… more
- Molina Healthcare (Warren, MI)
- …set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience, ... responsible for review of documentation to ensure medical necessity and appropriate...appropriate/accurate billing and claims processing. + Identifies and reports quality of care issues. + Assists with Complex Claim… more
- Veterans Affairs, Veterans Health Administration (Bay Pines, FL)
- …group of patients and will serve as a liaison for risk management, peer review , patient safety, and accreditation within Quality Service. Responsibilities The ... Quality Systems (QS) Specialist Registered Nurse (RN) demonstrates leadership, experience, and creative approaches to improvement in quality -of-care outcomes.… more
- Veterans Affairs, Veterans Health Administration (Ann Arbor, MI)
- …skills. Effectively utilizes all aspects of the nursing process to provide optimal quality review of surgical care provided to patients undergoing operative ... Kettles VA Medical Center is seeking a Full-Time Registered Nurse (RN) - VASQIP Quality Coordinator, aligned under Quality Management. Responsibilities The… more