- 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
- 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
- Albany Medical Center (Albany, NY)
- …America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients. * Completes ... Utilization Management and Quality Screening for assigned patients.* Applies MCG criteria to monitor appropriateness of admissions and continued stays, and documents… 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
- Dignity Health (Gilbert, AZ)
- …for appropriate status determination. + Ensures compliance with principles of utilization review , hospital policies and external regulatory agencies, Peer ... the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use of… more
- Beth Israel Lahey Health (Milton, MA)
- …lives.** POSITION FUNCTION: Reporting directly to the Manager, Patient Safety, the Quality Nurse Specialist performs duties in relation to the abstraction, ... and Medicaid Services (Mass. Health) prior to deadlines. The Quality Nurse Specialist works closely with the...to identify, prepare and coordinate the creation of peer review documents for medical staff and nonmedical staff … more
- Humana (Madison, WI)
- … Quality Reviews (AQR), and External Quality Reviews (EQR). The Quality Compliance Nurse fosters a culture of quality improvement by designing ... help us put health first** Humana is seeking a Quality Compliance Nurse to support the Wisconsin...credentialing/re-credentialing functions; and as needed to staff dedicated to review , analysis and response to quality concerns,… more
- Banner Health (AZ)
- …5. Identifies potential risk management FWA and Compliance issues during process of quality review for referral to the Risk Management and other appropriate ... remote and hybrid opportunities. As a Health Plan Registered Nurse RN Behavioral Health Quality of Care,...Health Plan members that have been referred to the Quality Management Department for review and resolution.… more
- Cleveland Clinic (Concord Township, OH)
- …multi-disciplinary care team or with other specialty areas as necessary. + Participates in quality monitoring thru the review of records and treatment plans for ... is currently seeking an experienced, self-motivated Physician Assistant or Certified Nurse Practitioner (_ **_Family, Primary, Acute_** _) for a full-time position… more
- HCA Healthcare (Plano, TX)
- …**Are you passionate about delivering patient-centered care?** Submit your application for Quality Analyst Registered Nurse position and spend more time at ... ensuring that the projects meet the identified internal and external standards; and is instrumental in promoting culture change...in your career! We are interviewing candidates for our Quality Analyst Registered Nurse opening. **Apply today… more
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