- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical necessity and level of care using...relationships with patients, families, interdisciplinary team members, payers, and external case managers; listens and responds to the ideas… more
- Actalent (Sunrise, FL)
- Actalent is hiring a Utilization Management Nurse ! Job Description The Utilization Management Nurse (UMN) collaborates closely with the interdisciplinary team to ... in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care, ensuring smooth… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse !Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization requests to ensure ... staff to direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, utilizing… 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
- 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
- Lompoc Valley Medical Center (Lompoc, CA)
- …and peer review . The QA nurse supports concurrent oversight and review of clinical quality measures and evidence based standards of care for the ... supervisor of Quality /Risk and Infection Control. The Quality Assurance (QA) nurse supports the ...improvement goals/priorities and in leading improvement efforts related to Quality /Peer Review . + Collaborate with external… more
- UHS (Binghamton, NY)
- Position OverviewUnited Health Services (UHS) is seeking a Quality Management Nurse Analyst to support our commitment to excellence in patient care and safety. ... In this analytical and clinically focused role, you will review clinical data, monitor quality metrics, and...agencies and organizational policies. Tracks Plans of Correction to external agencies to ensure follow up and compliance with… more
- CVS Health (Phoenix, AZ)
- …care health plan administered by Aetna, a CVS Health company, is seeking a Quality Management Nurse Consultant to help ensure the highest standards of care ... heart of a local team, you'll help shape the quality of care for families, children, seniors, and individuals...role for you! **Key Responsibilities** + Responsible for the review and evaluation of clinical information and documentation related… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …a sound understanding about the care of a particular patient population. + Chart review and data abstraction in support of quality measurement, analysis, and ... quality improvement, accreditation standards, internal process improvements and external regulatory requirements Assist in achieving goals of high quality… more
- Bon Secours Mercy Health (Newport News, VA)
- …accreditation, and certification surveys in successful completion. + Prepares and submits quality reports as required by external agencies and payors.Facilitates ... improvement committees and projects as needed. + Supports Medical Staff Quality and Peer Review . + Promotes practices that detect, mitigate or prevent harm using… more
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