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Rn Quality Review Jobs

Quality Mentor - Rn
By Beecan Health At Lakewood, CO, United States
Knowledge, Skills, Abilities & Qualifications
Responsible for pressure management oversight.
Responsible for fall management oversight.
Oversees management of psychotropic medications.
Guidance and skill development training abilities
Ensure that the employee skills, competency, and evaluations are within compliance.
Quality Review & Staff Education Specialist
By MJHS At , New York $92,276 - $115,345 a year
Minimum of two (2) years care management experience required.
Possess strong critical thinking skills and knowledge of Medicare and Medicaid regulations.
Strong interpersonal and organizational skills.
Excellent written and verbal communication skill.
Excellent analytic skills, interpretation of data.
Working knowledge of audit techniques and methodologies.
Coordinator Of Quality Review
By Lahey Hospital and Medical Center At , Burlington, 01805
Experience: Minimum of three years of clinical experience, two years in case, quality or utilization management.
9) Organizes and presents educational sessions related to projects and processes being managed.
10) Project manages disease management initiatives.
Participates in and successfully completes Mandatory Education.
Education: Graduate of a state approved and/or accredited School of Nursing
Licensure, Certification, Registration: Current license to practice professional nursing from the Massachusetts Board of Registration
Quality Coordinator - Rn
By Scripps Health At , Encinitas, 92024 $53.21 - $79.82 an hour
Requires attention to detail, analytical skills, excellent communication skills and intermediate computer skills.
Previous experience in quality improvement methods and tools preferred.
Knowledge of Core Measures or other publicly reported quality metrics preferred.
Familiarity with Joint Commission standards as they relate to Performance Improvement and/or Medical Staff Quality/Peer review strongly preferred.
Training and application of MIDAS or like-data based strongly preferred.
This is a full-time salaried position located at Scripps Memorial Hospital Encinitas.
Quality Peer Review (Rn)- Quality Management- Day Shift (Full Time)
By The George Washington University Hospital At , Washington, 20037
Experience with databases, data entry and/or database management preferred
Knowledge of Performance Improvement methodology and Outcomes Management
Expertise in Excel, PowerPoint, Ms Word, Database management
5 years of clinical experience in an acute care setting
Effective communication skills, both verbal and written
Knowledge of licensure regulations, Joint Commission on Accreditation of Healthcare Organization and state/federal standards
Quality Review & Monitoring Supervisor - 00056517
By Georgia Department of Community Health At , Atlanta, 30303 $57,331 - $81,000 a year
Experience working with Medicaid or a Care Management Organization (CMO)
Maintain thorough knowledge of applicable federal and state programmatic and statutory requirements as they apply to regulatory reviews
Experience reviewing or auditing healthcare related records or reports.
Experience coordinating, implementing, and evaluating healthcare reporting processes.
Strong knowledge of healthcare terminology
Strong written and oral communication/presentation skills
Quality Review Coordinator Jobs
By Baptist Health Arkansas At , Little Rock

Review Standard Operating Procedures annually

This job will be authorized 80.00 hours bi-weekly.

Concurrent Review Nurse, Rn - 23-246
By Hill Physicians Medical Group At , Sacramento

We’re delighted you’re considering joining us!

Rn-Quality Jobs
By Eisenhower Health At , Rancho Mirage, 92270
Preferred: Experience in performance / quality improvement activities
Performs post-discharge patient call backs to gage patient experience, address inquiries and remind patients of follow up appointments.
Vice President of Medical Affairs
Required: Minimum 3 years as a RN
Preferred: One year Nursing Inpatient
Interprets laboratory and test results and communicates abnormal findings to attending physician as needed.
Prn-Ur Clinical Review Rn - Support Center (Remote)
By Children's Healthcare of Atlanta At , Brookhaven, 30329

Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs). Work Shift Day ...

Quality Review & Staff Education Supervisor
By MJHS At , New York $101,503 - $126,879 a year
Master’s degree in nursing, education or related field preferred.
Sign-on Bonuses OR Student Loan Assistance for clinical staff
FREE Online RN to BSN and MSN degree programs!
Tuition Reimbursement for all full and part-time staff
Dependent Tuition Reimbursement for clinical staff!
Affordable medical, dental and vision coverage for employee and family members
Clinical Quality Review Specialist - Rn
By HCSC At , Richardson
Knowledge of managed care processes.
Organizational skills and ability to meet deadlines and manage multiple priorities.
Proficient with Milliman Care Guidelines (MCG) management.
5 years combine knowledge of healthcare processes.
Verbal and written communication skills to include interfacing with staff across organizational lines plus interfacing with members and providers.
PC experience to include Microsoft Word, Access, and Excel.
Benefit Review Rn - Remote | Wfh
By Get It Recruit - Healthcare At Philadelphia, PA, United States

Join our dynamic team and embark on an exciting journey in the world of healthcare management! We are seeking a passionate and dedicated individual to fill the role of Clinical Benefit Review ...

Quality Coordinator Rn Jobs
By Kaiser Permanente At , Harbor City, 90710, Ca $117,500 - $152,020 a year
Conducts special clinical studies related to patient care management.
Detailed knowledge of Title 22, TJC and NCQA requirements for licensure and accreditation.
Must be able to work in a Labor/Management Partnership environment.
Monitors compliance with quality improvement requirements.
Minimum two (2) years of experience as a licensed hospital nurse required.
Experience in a patient advocate role to insure a patient centered focus.
Kyc Quality Review Analyst-Fincen
By Pinnacle Group, Inc. At New York, NY, United States
Must have strong Aml/Kyc/Fincen knowledge
Strong verbal and written communication skills.
Reviews the FinCEN - Certification of Beneficial Ownership and determine it is aligned to the documentation on file
Conduct research over available internal and external systems, including the internet, as needed and escalate to manager when necessary.
Bachelor’s degree or commensurate work experience
4 to 6 years relevant work experience
Care Review Clinician, Inpatient Review (Rn) - Mississippi
By Molina Healthcare At , Starkville, Ms $26.41 - $51.49 an hour

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

To all current Molina employees:

Quality Review Supervisor Jobs
By MJHS At , New York, Ny $101,503 - $126,879 a year
Master’s degree in nursing, education or related field preferred.
Sign-on Bonuses OR Student Loan Assistance for clinical staff
FREE Online RN to BSN and MSN degree programs!
Tuition Reimbursement for all full and part-time staff
Dependent Tuition Reimbursement for clinical staff!
Affordable medical, dental and vision coverage for employee and family members
Quality Review Specialist Jobs
By MJHS At , New York, Ny $92,276 - $115,345 a year
Minimum of two (2) years care management experience required.
Possess strong critical thinking skills and knowledge of Medicare and Medicaid regulations.
Strong interpersonal and organizational skills.
Excellent written and verbal communication skill.
Excellent analytic skills, interpretation of data.
Working knowledge of audit techniques and methodologies.
Quality Regulatory Program Rn
By St Joseph Hospital & Medical Center At , Phoenix, 85013, Az $36.96 - $53.60 an hour
BS degree in nursing, health information management, healthcare administration, or equivalent healthcare experience required.
Three years experience in healthcare nursing, quality, compliance, health information management, and/or equivalent healthcare experience required.
Strong computer proficiency; strong verbal and written communication skills; analytical skills.
BSN;Certified Professional Healthcare Quality (CPHQ)
Medical Review Rn -Experienced - Home Or Office Based
By Qlarant At Dallas, TX, United States
Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
ICD-9 coding, CPT coding, and knowledge of Medicare and/or Medicaid regulations preferred. CPC or similar certification preferred.
Completes desk review or field audits to meet applicable contract requirements and to identify evidence of potential overpayment or fraud.
Consults with Benefit Integrity investigation experts and pharmacists for advice and clarification.
Responsible for case specific or plan specific data entry and reporting.
Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data.