- 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 (Walla Walla, WA)
- …limited to: Providing leadership in assessing, planning, implementing, and evaluating Quality Management processes at the facility. Identifying inherent risk through ... mitigation and financing. Providing oversight of the protected peer review process in collaboration with the Chief of Staff...and being a productive member of committees and the Quality and Patient Safety Council. Consulting with staff regarding… 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 (Bronx, NY)
- …apply. Responsibilities The James J. Peters VA Medical Center is recruiting for 1 Quality Management Registered Nurse for the Renal Transplant Program. At the ... the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible...include but are not limited to the following: The Quality Management (QM) Registered Nurse (RN) demonstrates… more
- Veterans Affairs, Veterans Health Administration (Brockton, MA)
- …outcomes. Effectively utilizes all aspects of the nursing process to provide optimal quality review of surgical care provided to patients undergoing operative ... Summary This Registered Nurse (Surgery Quality Improvement Program) position is located within the Surgical Care Service of the VA Boston Healthcare System at… more
- Centene Corporation (Phoenix, AZ)
- …overall team needs. Reviews outcomes in accordance with National Committee for Quality Assurance (NCQA) standards. Works with senior management to identify and ... logs of actions and/or decisions are appropriately documented + Performs clinical review of outcomes including creating and editing denial letters with the… more
- BJC HealthCare (St. Louis, MO)
- …(commercial, behavioral health, inpatient, ect) **Requirements:** + 2 years of staff nurse experience performing care for hospitalized patients. + 2 years of ... utilization review (UR) experience reviewing hospital admissions for medical necessity...of the patient's payment structure while providing safe and quality care. Evaluate the cost and quality … more
- Molina Healthcare (Idaho Falls, ID)
- …HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical… more
- Beth Israel Lahey Health (Burlington, MA)
- …and the Medical Director of the Clinical Service, the Cardio Serv Clin Rev Nurse works to ensure all database forms are accounted for, completed, and clinically ... includes maintaining and updating the data as necessary. 5. Participates in quality assurance processes to ensure data integrity. This involves routine audits of… more
- HCA Healthcare (Anchorage, AK)
- …nurses set us apart from any other healthcare provider. We are seeking a Quality Registered Nurse to join our healthcare family. **Benefits** Alpine Surgery ... their passion for patient care. Apply today for our Quality Registered Nurse opportunity. **Job Summary and...+ You will oversee safety in-service programs + Maintain, review , receive and report all variances for your center… more
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