6 utilization review nurse rn jobs found

POSITION SUMMARY/RESPONSIBILITIES Provides strategic leadership for Utilization Management programs and initiatives. Responsible for accreditation readiness, regulatory compliance oversight, performance improvement planning, delegated oversight, operational governance, and implementation of organizational UM strategies. Serves as a liaison between operational leadership, Medical Directors, executive leadership, regulatory agencies, and accreditation organizations. Provides leadership, oversight, direction, and performance management for Utilization Management staff, including clinical reviewers, denial and appeals staff, and administrative personnel. Oversees utilization review operations, prior authorization activities, concurrent review, retrospective review, appeals support, and regulatory compliance activities. Ensures consistent application of medical necessity criteria, regulatory requirements, accreditation standards, and organizational policies. Leads quality...

POSITION SUMMARY/RESPONSIBILITIES Provides support for the Health System's quality improvement functions through the analysis of data and indicators. Responsible for identifying and monitoring ongoing quality improvement issues and opportunities. Assists in the development of process metrics, data collection tools and presentations of resultant data throughout the Health System. Serve as facilitator/leader of process improvement efforts. Engages with Senior Leadership, Department Directors, Educators, and their staff and physician/provider leaders/representatives. Work collaboratively with all members of the healthcare team. Reviews patient information, screening the information through the appropriate review process for accurate and complete documentation of a patient's care to meet quality guidelines and regulations. EDUCATION/EXPERIENCE Bachelor's degree in nursing required. Three or more years of relevant clinical experience are required. Experience with...

POSITION SUMMARY/RESPONSIBILITIES Provides support for the Health System's quality improvement functions through the analysis of data and indicators. Responsible for identifying and monitoring ongoing quality improvement issues and opportunities. Assists in the development of process metrics, data collection tools and presentations of resultant data throughout the Health System. Serve as facilitator/leader of process improvement efforts. Engages with Senior Leadership, Department Directors, Educators, and their staff and physician/provider leaders/representatives. Work collaboratively with all members of the healthcare team. Reviews patient information, screening the information through the appropriate review process for accurate and complete documentation of a patient's care to meet quality guidelines and regulations. EDUCATION/EXPERIENCE Bachelor's degree in nursing required. Three or more years of relevant clinical experience are required. Experience with...

POSITION SUMMARY/RESPONSIBILITIES Provides support for the Health System's quality improvement functions through the analysis of data and indicators. Responsible for identifying and monitoring ongoing quality improvement issues and opportunities. Assists in the development of process metrics, data collection tools and presentations of resultant data throughout the Health System. Serve as facilitator/leader of process improvement efforts. Engages with Senior Leadership, Department Directors, Educators, and their staff and physician/provider leaders/representatives. Work collaboratively with all members of the healthcare team. Reviews patient information, screening the information through the appropriate review process for accurate and complete documentation of a patient's care to meet quality guidelines and regulations. EDUCATION/EXPERIENCE Bachelor's degree in nursing required. Three or more years of relevant clinical experience are required. Experience with...

POSITION SUMMARY/RESPONSIBILITIES Provides support for the Health System's quality improvement functions through the analysis of data and indicators. Responsible for identifying and monitoring ongoing quality improvement issues and opportunities. Assists in the development of process metrics, data collection tools and presentations of resultant data throughout the Health System. Serve as facilitator/leader of process improvement efforts. Engages with Senior Leadership, Department Directors, Educators, and their staff and physician/provider leaders/representatives. Work collaboratively with all members of the healthcare team. Reviews patient information, screening the information through the appropriate review process for accurate and complete documentation of a patient's care to meet quality guidelines and regulations. EDUCATION/EXPERIENCE Bachelor's degree in nursing required. Three or more years of relevant clinical experience are required. Experience with...

POSITION SUMMARY/RESPONSIBILITIES Provides support for the Health System's quality improvement functions through the analysis of data and indicators. Responsible for identifying and monitoring ongoing quality improvement issues and opportunities. Assists in the development of process metrics, data collection tools and presentations of resultant data throughout the Health System. Serve as facilitator/leader of process improvement efforts. Engages with Senior Leadership, Department Directors, Educators, and their staff and physician/provider leaders/representatives. Work collaboratively with all members of the healthcare team. Reviews patient information, screening the information through the appropriate review process for accurate and complete documentation of a patient's care to meet quality guidelines and regulations. EDUCATION/EXPERIENCE Bachelor's degree in nursing required. Three or more years of relevant clinical experience are required. Experience with...