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CAREERBUILDER APPLY

Full Time

Our client is currently seeking a Quality Improvement Nurse This job will have the following responsibilities: Conducts review of member grievances related to Quality of Care and Quality of service ...

Maryland Heights, MO, USA

Full Time

Refers cases for Quality Management review and Special Investigative Review as indicated for quality of care issues and possible abuse/fraud. ... in UM, UR, claims auditing or case management *Certifications preferred: Eligible for certification within three years of hire as CCM, CPUR, Certified Medical Audit Specialist [or other nationally recognized nurse auditor ...

9521 San Mateo Blvd NE, Albuquerque, NM 87113, USA

CAREERBUILDER APPLY

Full Time

Provide analysis and identify trends to track progress with improvement strategies and coordinate with Leadership and regional nurses to provide training that is required to sustain improvement. ... Work with community and company leadership teams to assist in ensuring there is a Continuous Quality Improvement (CQI) activity in the building and identifying and setting priorities in resolving service ...

Providence, RI, USA

Full Time

These nurses will be joining a new department that used to be outsourced for many years with Cognizant. This company has decided to bring ... Identify quality, cost and efficiency trends and provide solution recommendations to Supervisor/ Manager. * Actively participate on assigned ...

Farmington, CT, USA

CAREERBUILDER APPLY

Full Time

The Prior Auth Nurse (LPN or LVN) position facilitates the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities ... Promotes/supports quality effectiveness of Healthcare Services and benefit utilization -Utilizes clinical skills to support coordination, documentation and communication of medical services and/or benefit ...

Confidential

Richmond, VA, USA

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CAREERBUILDER APPLY

Full Time | Pay: $110,000/year

Manage and monitor clinical quality studies to include receipt and analysis of trended data, assessment of national benchmarks as available, development of improvement recommendations (to ... or Master's Degree in Nursing required; 3+ years of experience in managed care organization or hospital environment; 3+ years of experience in QI, data analysis and initiation of improvement initiatives that ...

Newark, NJ, USA

Full Time | Pay: $45 - $50/hour

Registered Nurse Case Manager ... available resources required to meet the Member's health care needs through clear communication and advocacy that aims to promote quality cost-effective interventions based on medical necessity and compliance with the Member's Health Plan.

Woodland Hills

Full Time

UTILIZATION MANAGEMENT NURSE ESSENTIAL JOB FUNCTIONS (include the following): 1. Effectively manage utilization trends to ... Identifies potential quality of care issues, service, or treatment delays & intervenes or as clinically appropriate. Current active unrestricted CA RN ...

Rancho Cordova, CA 95670, USA

CAREERBUILDER APPLY

Full Time

Our Utilization Management Nurse will provide service and support to members and health care providers, including pre-service reviews, out of network referrals and support for Client's Health Plan of ...

Des Moines Iowa

Full Time

Education. Graduate of a school of nursing required. Bachelor in Nursing/ Science is preferred. Experience. 2 years' experience in quality or regulatory compliance to include at least 1 year responsible ...

700 E Marshall Ave, Longview, TX 75601, USA

CAREERBUILDER APPLY

Full Time

Judge Healthcare is currently seeking a Utilization Management Nurse for one of our best clients in Miami, FL!! All interested and qualified ... Participates in network development including identification and recruitment of quality providers as needed. Advocates for the enrollee to ...

Doral, FL, USA

CAREERBUILDER APPLY

Full Time | Pay: $85,000/year

Utilization Management Registered Nurse needed for a full-time, direct hire opportunity with Yoh's client located in Santa Barbara, CA. ... implementation and the evaluation of department initiatives with the intent to assess any measurable improvements to member's quality of care; Perform selective claims review, and occasional onsite review; Adhere to regulatory ...

Yoh

Santa Barbara, CA 93110, USA

Full Time

The Quality Improvement Coordinator is responsible for analyzing data interdepartmentally, developing and implementing performance improvement processes under the auspices of the Performance ...

10700 McPherson Rd, Laredo, TX 78045, USA

Full Time

Job Summary: The Case Manager is a registered nurse who enhances the quality of patient management, maximizes satisfaction and promotes cost- effectiveness. The employee will be accountable for ...

1510 Meadow Wood Ln, Reno, NV 89502, USA

CAREERBUILDER APPLY

Full Time

Qualifications of the Quality Assurance Nurse (LPN): Must have good standing license (LPN) in the state in which the clinician will practice; Must have 1 year of quality improvement and charting ...

Englewood, CO, USA

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Full Time

Provides primary nursing care for inpatient and continuous care patients as assigned. Quality Improvement. Participates in the Quality Assessment and Performance Improvement (QAPI) Program and ...

580 Waters Edge Ln, Lombard, IL 60148, USA

CAREERBUILDER APPLY

Full Time | Pay: $28 - $34/hour

Are you an experienced Utilization Review Nurse looking for a new opportunity with an award-winning health plan? Are you a Registered Nurse excited to utilize your license with a Fortune 100 health ...

New Albany, OH 43054, USA

Full Time

Program Planning and Treatment: Review the effectiveness of the comprehensive interface with external reviewers, communicate with external reviewers and managed care organizations to assure timely and appropriate interactions, monitor outcomes of reviews a...

2695 N Craycroft Rd, Tucson, AZ 85712, USA

Full Time

The Performance Improvement Coordinator for Emergency Service Admin reports to the Director of Quality and Patient Safety and is responsible for coordinating and facilitating performance improvement teams ... Graduate of an accredited School of Nursing (Bachelor's Degree preferred) with current Georgia Registered Nurse license; or Graduate of an accredited college or university ( Bachelor's Degree ...

Austell, GA 30168, USA

Full Time

Anchorage Nursing & Rehabilitation Center currently has an opening for an RN with MDS experience! This position ... Work with established departmental, center and corporate policies and procedures, objectives, quality improvement program, and safety environment. Participate in ...

Salisbury, MD 21801, USA

Full Time

The nurse also promotes optimal person-centered care that supports and empowers individuals, respects individual choices and meets the health care needs of patients. MAJOR ... Demonstrates behaviors and actions that support the mission, goals, and operations of the CHRISTUS Health System and which contribute to the continuous quality improvement.

919 Hidden Ridge, Irving, TX 75038, USA

CAREERBUILDER APPLY

Full Time

This position participates in quality improvement, training and monitoring of all staff completing the MDS process. Oversees and ... Attends weekly nursing/MDS/ Triple check update meeting. Issue denial ...

Bloomfield, CT 06002, USA

Full Time

We are looking for a sharp, enthusiastic, professional to become part of the energy and join our Performance Improvement team where you will engage in our efforts to improve patient satisfaction, clinical ... Works with physicians, nurses , and organization- wide health team members to ensure quality patient care by delivery of evidence-based best practices.

Miami Beach, FL, USA

Full Time

Frances Cabrini's strategic plan and the goals and direction of their Performance Improvement Plan (PIP). ... Initiates and contributes to modifications/changes in nurse and physician practice pattern to achieve quality of care, patient satisfaction and appropriate use of resources.

3330 Masonic Dr, Alexandria, LA 71301, USA

CAREERBUILDER APPLY

Full Time

Identifying quality of care and savings opportunities, negotiating with providers when needed, facilitating the use of appropriate extra-and-contractual benefits, and providing the member with information ... Keywords: RN, Registered Nurse, nursing, case manager, case management, care manager, care management, nurse case manager, telephonic case manager, in office case manager, home health, ...

Detroit, MI, USA

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