• University Health (San Antonio, TX)
    … Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), and/or Registered Nurse (s) ( RN ) are highly preferred. ... Assurance (NCQA) that promotes Healthcare Effectiveness Data and Information Set ( HEDIS ) metrics, Utilization Review Accreditation Commission (URAC), and the… more
    job goal (12/04/25)
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  • RN HEDIS Review Nurse

    Amergis (Houston, TX)
    Amergis Healthcare Staffing is seeking a Pediatric Registered Nurse ( RN ) to assume responsibility and accountability for the application of the nursing ... process and the delivery of patient care. The Pediatric Registered Nurse ( RN ) demonstrates ability to make clinical judgments in an effective and efficient… more
    Amergis (12/03/25)
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  • Clinical Nurse Auditor, HEDIS

    Providence (WA)
    …we must empower them. **Required Qualifications:** + Degree in Nursing + Oregon Registered Nurse License + 5+ years clinical experience (Nursing) **Preferred ... using objective specifications for the Healthcare Effectiveness and Data Information Set ( HEDIS ) program. Audits include review of outpatient medical records,… more
    Providence (11/18/25)
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  • Case Manager, Maternity ( Registered

    Excellus BlueCross BlueShield (Rochester, NY)
    …varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, ... All Levels + Associates degree required. Bachelor's degree preferred. + Active NYS RN or Registered Dietician or Physical Therapist licensure required. + Minimum… more
    Excellus BlueCross BlueShield (11/26/25)
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  • Senior Medical Management Nurse - VCHCP

    Ventura County (Ventura, CA)
    …CNA_MOA_2023-2028.pdf (ventura.org) (https://vcportal.ventura.org/CEO/HR/MOA/docs/CNA\_MOA\_2023-2028.pdf) PAYROLL TITLE: Senior Registered Nurse - Ambulatory ... Care DISTINGUISHING CHARACTERISTICS: The Senior Registered Nurse -Ambulatory Care series is distinguished from other nursing classifications in that they are… more
    Ventura County (11/07/25)
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  • Utilization Review RN

    Community Health Systems (Naples, FL)
    Join us as a ** Registered Nurse ( RN ) - Utilization Review position** at Physicians Regional Collier Unit: Utilization Review Shift: Mon-Fri (this is ... for Full and Part-Time roles **Job Summary** The Utilization Review Nurse - RN reviews...patient-centered service and continuous improvement. **Licenses and Certifications** + RN - Registered Nurse -… more
    Community Health Systems (11/20/25)
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  • RN

    Catholic Health Services (Melville, NY)
    Overview Position Summary: The Registered Nurse provides safe, direct patient care utilizing the nursing process in the ambulatory setting. The RN provides ... clinical leadership and is a resource for staff. The Registered Nurse must show an uncompromising commitment...staff meetings and huddles as appropriate. + Participates in Hedis , GPRO, and other quality programs as needed +… more
    Catholic Health Services (09/17/25)
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  • RN Care Coordinator II

    Covenant Health Inc. (Knoxville, TN)
    Overview Registered Nurse Care Coordinator, Quality Management Full Time, 80 Hours Per Pay Period, Day Shift About Us Covenant Medical Group employs or manages ... a proud member of Covenant Health! Position Summary: The RN Care Coordinator II is responsible for integrating evidenced...coordination services within the scope of practice as a registered nurse meeting all required standards both… more
    Covenant Health Inc. (10/10/25)
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  • Quality Management Clinical Nurse

    UCLA Health (Los Angeles, CA)
    Description The Quality Management Nurse is responsible for conducting comprehensive facility site reviews (FSRs) to ensure compliance with healthcare standards and ... facilitate appropriate Health Education opportunities. Additionally, you will performs HEDIS related activities, Pay for Performance activities, Provider Access and… more
    UCLA Health (10/12/25)
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  • Health Plans Licensed Practical Nurse LPN…

    Banner Health (AZ)
    …employment settings by including remote and hybrid opportunities. As a **Licensed Practical Nurse (LPN)** for **Banner Health Plans** , you will be an integral part ... Management Team** . This assignment-based role focuses on independent chart review and clinical assessment. **Key Responsibilities** : + Independently review more
    Banner Health (11/27/25)
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