- Cleveland Clinic (Vero Beach, FL)
- …healthcare experience, including physical, educational, emotional and spiritual needs. As SQPE Specialist II, you play an essential part in this mission by ensuring ... compliance with all standards and favorable performance on safety, quality, utilization and experience metrics. + Participate in engraining the safety, quality… more
- University of Washington (Seattle, WA)
- …care principles, including documentation accuracy, care gap closure, care coordination, and utilization management . + Use analytics to identify risk and care ... has an outstanding opportunity for a Value-Based Care Performance Specialist WORK SCHEDULE 100% FTE Hybrid - Onsite as...risk gaps, enhance quality, and strengthen care and value management . + Evaluate access and capacity constraints and support… more
- University of Utah (Salt Lake City, UT)
- Details **Open Date** 11/19/2025 **Requisition Number** PRN43626B **Job Title** PS Clinical Nurse Specialist **Working Title** PS Clinical Research Nurse ... and qualifications required of employees assigned to the job. The Clinical Nurse Specialist makes decisions independently and in collaboration with the… more
- Sanford Health (Fargo, ND)
- …learning about accreditation and working as part of a cohesive team this program specialist role could be a great fit! **Job Summary** Responsible for analyzing and ... synthesizing of data to maximize utilization of data in clinical decision-making, business and strategic initiative. Coordinates educational activities associated… more
- LA Care Health Plan (Los Angeles, CA)
- …the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The position serves as a subject matter ... can include inpatient, outpatient, and professional claims. Serves cross functionally with Utilization Management , Medical Directors, and other internal teams to… more
- Fenway Health (Boston, MA)
- Registered Nurse Boston, MA (http://maps.google.com/maps?q=1340+Boylston+St+Boston+MA+USA+02215) * Nursing Job Type Full-time Description As a Registered Nurse ... care to individuals, families, communities, and patient populations. The Registered Nurse 's care delivery is consistent with the Massachusetts Board of Registration… more
- Veterans Affairs, Veterans Health Administration (Georgetown, DE)
- …and Experience, and Dimension criteria must be met to qualify for Advanced Practice Nurse (Clinical Nurse Specialist ) II: Exception to Licensure for Graduate ... teamwork, high quality care, patient satisfaction, positive outcomes, appropriate utilization of resources and cost-effective services. The Nurse...of the Nurse II, as a Graduate Nurse Technician Clinical Nurse Specialist … more
- Guthrie (Binghamton, NY)
- …of the clinical manager / director, clinical educator, and/or clinical nurse specialist , department competencies, educational programs, new employee orientation, ... hire. Experience: Two years of recent clinical supervisory experience or charge nurse experience desired Essential Functions: RESOURCE UTILIZATION : + Considers… more
- MyFlorida (Chattahoochee, FL)
- …SHIFTS. This is a highly responsible and professional position serving as a Registered Nurse Specialist within Nursing Services. The ideal candidate will be a ... REGISTERED NURSE SUPERVISOR - 60005446 Date: Jan 8, 2026...Ability to analyze complex reports and determine the service utilization habits of clients and to evaluate the appropriateness… more
- Molina Healthcare (WI)
- …chief medical officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes...be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and… more