• Utilization Review / Quality…

    SUNY Upstate Medical University (Syracuse, NY)
    Job Summary: The Utilization Review / Quality Assurance Coordinator is responsible for all compliance related paperwork and ensures all compliance ... paperwork is completed in a timely manor for the Upstate/Syracuse City School District school-based mental health care program. This position helps ensure successful visits by DNV and OMH when they occur. Monitors and maintains performance improvement… more
    SUNY Upstate Medical University (06/03/25)
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  • Regional Medical Director, Care Management…

    UPMC (Pittsburgh, PA)
    …managed care organizations, providers, and payers to address benefit coverage, utilization review , and quality assurance . + Promote adherence to URAC ... The Regional Medical Director, CC/DP and Utilization Review , provides clinical and management...quality and cost-effectiveness of patient care. + Analyze utilization data to identify trends and implement strategies to… more
    UPMC (07/11/25)
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  • Utilization Review Nurse (40 Hour)

    State of Connecticut, Department of Administrative Services (New Haven, CT)
    …and medical care delivery and reimbursement systems; + Participates in utilization review and/or quality assurance programs; + Conducts various types of ... Utilization Review Nurse (40 Hour) Office/On-Site...quality and appropriate medical management, cost containment, peer review and rehabilitation; + Summarizes and analyzes data; +… more
    State of Connecticut, Department of Administrative Services (07/23/25)
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  • Asst Utilization Coordinator

    WMCHealth (Valhalla, NY)
    …hospital or health care agency, one of which must have been in the area of utilization review , quality assurance , risk management or discharge planning. ... the implementation or investigation of the procedures specified in the Quality Management, Utilization Review and Discharge Planning Program at Westchester… more
    WMCHealth (07/01/25)
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  • LVN - Quality Assurance…

    Emanate Health (Covina, CA)
    …States, and the #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity ... using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity… more
    Emanate Health (07/23/25)
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  • Non-Clinical Coding and OASIS Review…

    BAYADA Home Health Care (Orlando, FL)
    …should be available Monday-Friday from 8:30am-5:00pm. _Medicare, Coder, OASIS Review , Utilization Review , Quality Assurance , Remote, Home Health ... Home Health Care is hiring a full time OASIS Review and Coding Manager. The OASIS and Coding ...monitoring Outcome and Assessment Information Set (OASIS) documentation for quality and adherence to policies and procedures. As a… more
    BAYADA Home Health Care (07/01/25)
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  • Clinical Coding and OASIS Review Manager

    BAYADA Home Health Care (Orlando, FL)
    …with an industry leader. Apply now for immediate consideration. OASIS Review , Utilization Review , Quality Assurance , Remote, Home Health Coding, ... Home Health Care has an immediate opening for a **Full Time,** OASIS and Coding Review Manager with OASIS and Coding certification to work remotely. RN, PT, OT, and… more
    BAYADA Home Health Care (07/01/25)
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  • Case Manager Utilization Review…

    Beth Israel Lahey Health (Burlington, MA)
    …coordinates utilization review , discharge planning and monitors quality assurance for Lahey Clinic inpatient admissions. Leads the multidisciplinary ... in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient...needed. 10) Supports all service line activities related to utilization and quality management. 11) Assists in… more
    Beth Israel Lahey Health (05/11/25)
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  • Medical Director

    Centene Corporation (Tallahassee, FL)
    … quality improvement activities. + Performs medical review activities pertaining to utilization review , quality assurance , and medical review ... + Provides medical expertise in the operation of approved quality improvement and utilization management programs in...with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends… more
    Centene Corporation (07/19/25)
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  • Case Manager (RN) - Timely Discharge - Full-time…

    Stanford Health Care (Palo Alto, CA)
    …management, including the principles and practices of discharge planning, utilization review , and quality assurance /improvement + Knowledge of the ... responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient… more
    Stanford Health Care (07/22/25)
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