184 utilization review nurse jobs found

System Utilization Review Nurse Manager - ( 29-8136-MGMT-011224 ) Description Baptist Health is the largest healthcare system serving central Alabama, providing comprehensive hospital-based and outpatient services to nearly 60 percent of the residents in Montgomery, Autauga and Elmore counties. To learn more about Baptist Health, visit us at https://www.baptistfirst.org. The RN – Utilization Review Nurse Manager shall manage the daily Utilization Review and Appeals Management processes for the facilities within Baptist Health. This individual shall administer policies and operational procedures necessary to coordinate the resources needed for utilization review and appeal management. Additionally, the Manager shall be responsible for allocation and management of human resources in assigned departments. The Manager is responsible to manage a team of Utilization Review and Appeal Management Specialists, to develop and implement utilization review protocols, and collaborate with...

Performs clinical review of patient records to evaluate the utilization of acute care services. Communicates to third party payors to support the medical necessity of the hospital admission for services reimbursement. Ensures the patient care team is aware of general length of stay requirements for all patients. Facilitates physician documentation through concurrent interaction with physicians to support reimbursement and clinical severity is captured for the service rendered to patients receiving hospital care. Provides clinical knowledge and data collection for quality improvement initiatives. Optimizes reimbursement for acute care services. This is not a remote position.

At Houston Methodist, the Clinical Documentation Specialist is responsible for improving the overall quality and completeness of clinical documentation. This position analyzes medical records for DRG's, complications, and comorbidities; identifies trends; and notes observations and recommendations for documentation improvement. This role also facilitates modifications to clinical documentation through extensive interaction with physicians, nursing staff, other patient care givers, and medical records coding staff to ensure that appropriate reimbursement is received for the level of service rendered to all patients. Additional duties include supporting the accuracy and completeness of the clinical information used for measuring and reporting physician and hospital outcomes and educating all members of the patient care team on an ongoing basis. PEOPLE ESSENTIAL FUNCTIONS Improves the overall quality, completeness and accuracy of clinical documentation by performing open...

At Houston Methodist, the Clinical Documentation Specialist is responsible for improving the overall quality and completeness of clinical documentation. This position analyzes medical records for DRG's, complications, and comorbidities; identifies trends; and notes observations and recommendations for documentation improvement. This role also facilitates modifications to clinical documentation through extensive interaction with physicians, nursing staff, other patient care givers, and medical records coding staff to ensure that appropriate reimbursement is received for the level of service rendered to all patients. Additional duties include supporting the accuracy and completeness of the clinical information used for measuring and reporting physician and hospital outcomes and educating all members of the patient care team on an ongoing basis. PEOPLE ESSENTIAL FUNCTIONS Improves the overall quality, completeness and accuracy of clinical documentation by performing open...

Position Overview The Hospice Registered Nurse is responsible for pain management, symptom control in the delivery of care to hospice patients, as established by the plan of care, the interdisciplinary team, attending physician and Hospice Medical Director.  Essential Job Functions: Ensures the timely and adequate delivery of hospice services to the terminally ill patient and their family, operating within the plan of care as established by the hospice team and attending physician. Assesses the total needs of the patient/family during regularly scheduled and after hour home visits; Documents: assessment, identified problems, nursing interventions, goals, and outcomes of interventions.  Coordinates total patient/family hospice care under the supervision of the Director and with the interdisciplinary team, the attending physician, and other providers; documents such coordination. Collaborates with the interdisciplinary team in the development, review and revision of...

At Houston Methodist, the Clinical Documentation Specialist is responsible for improving the overall quality and completeness of clinical documentation. This position analyzes medical records for DRG's, complications, and comorbidities; identifies trends; and notes observations and recommendations for documentation improvement. This role also facilitates modifications to clinical documentation through extensive interaction with physicians, nursing staff, other patient care givers, and medical records coding staff to ensure that appropriate reimbursement is received for the level of service rendered to all patients. Additional duties include supporting the accuracy and completeness of the clinical information used for measuring and reporting physician and hospital outcomes and educating all members of the patient care team on an ongoing basis. PEOPLE ESSENTIAL FUNCTIONS Improves the overall quality, completeness and accuracy of clinical documentation by performing open...

At Houston Methodist, the Clinical Documentation Specialist is responsible for improving the overall quality and completeness of clinical documentation. This position analyzes medical records for DRG's, complications, and comorbidities; identifies trends; and notes observations and recommendations for documentation improvement. This role also facilitates modifications to clinical documentation through extensive interaction with physicians, nursing staff, other patient care givers, and medical records coding staff to ensure that appropriate reimbursement is received for the level of service rendered to all patients. Additional duties include supporting the accuracy and completeness of the clinical information used for measuring and reporting physician and hospital outcomes and educating all members of the patient care team on an ongoing basis. PEOPLE ESSENTIAL FUNCTIONS Improves the overall quality, completeness and accuracy of clinical documentation by performing open...

General Summary of Position The Assistant Director of Nursing is a member of MedStar Health entity-based Division of Nursing and leadership team. Supports and collaborates with the Director of Nursing in providing leadership and oversight for a specific unit/department. Directs and coordinates the nursing and patient care delivery of the unit-based professional and support personnel. Ensures the provision of holistic, culturally competent, and person-centered, quality, safe, and cost-effective evidence-based nursing care for patients/families. Applies the nursing process within the context of the organization's shared/collaborative decision-making framework. Collaboratively manages the patient's transitions across the continuum of care to assist patients and populations in achieving or maintaining an optimal level of health and functioning. The Assistant Director of Nursing assumes administrative and leadership authority and responsibility during a specific shift (e.g.,...

General Summary of Position The Clinical Administrator is a member of MedStar Health entity-based Division of Nursing and leadership team. The role is accountable for directing and supervising clinical and administrative resources to ensure the provision of holistic, culturally competent, quality, safe, and cost-effective evidence-based nursing care for patients and families. This is accomplished by direct action, delegation, coaching and support of the Division of Nursing's associates and shared/collaborative governance activities. The Clinical Administrator is recognized as a professional role model and clinical expert who promotes a professional practice and care environment that supports continuous learning. The Clinical Administrator assumes leadership authority and responsibility during a specific shift (e.g., day, evening, night, and/or weekend) either for a designated number of patient care units/departments or the hospital at large. Collaborates with the members of...

General Summary of Position The Assistant Director of Nursing is a member of MedStar Health entity-based Division of Nursing and leadership team. Supports and collaborates with the Director of Nursing in providing leadership and oversight for a specific unit/department. Directs and coordinates the nursing and patient care delivery of the unit-based professional and support personnel. Ensures the provision of holistic, culturally competent, and person-centered, quality, safe, and cost-effective evidence-based nursing care for patients/families. Applies the nursing process within the context of the organization's shared/collaborative decision-making framework. Collaboratively manages the patient's transitions across the continuum of care to assist patients and populations in achieving or maintaining an optimal level of health and functioning. The Assistant Director of Nursing assumes administrative and leadership authority and responsibility during a specific shift (e.g.,...

We’re unique.  You should be, too. We’re changing lives every day.  For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts?  Do you inspire others with your kindness and joy? We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team. We’re unique. You should be, too. We’re changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy? We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical operations team and is responsible for providing direct patient care in ChenMed/Dedicated medical centers. The responsibilities include but are not limited to:...

Job Requirements The Nurse Practitioner must demonstrate the ability to function both independently and in collaboration with other health care professionals. Consults with the manager, physician, and medical director to ensure compliance with guidelines. This position may require participation in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards of performance, regulatory compliance, quality patient care compliance, and policies and procedures. Functions independently as a certified nurse practitioner for a patient population in collaboration and consultation with a licensed patient care team physician. Practices in accordance with a written or electronic practice agreement. Work Experience ESSENTIAL JOB DUTIES/RESPONSIBILITIES: Independently assesses acute and non-acute clinical problems. Performs and documents physical assessments and patient...

We’re unique.  You should be, too. We’re changing lives every day.  For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts?  Do you inspire others with your kindness and joy? We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical operations team and is responsible for providing direct patient care in ChenMed/Dedicated medical centers. The responsibilities include but are not limited to: geriatric assessment, medical history, physical exam, diagnosis and treatment, development of the nursing plan of care, health education, physician referrals, case management referrals, follow-up and clear documentation according to ChenMed standards for quality, service, productivity and teamwork. It also includes the participation in clinical rounds and conferences plus in-depth...

We’re unique.  You should be, too. We’re changing lives every day.  For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts?  Do you inspire others with your kindness and joy? We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical operations team and is responsible for providing direct patient care in ChenMed/Jencare medical centers, nursing homes, skilled nursing facilities (SNF) and home settings depending on the nature of the assignment or providing assessments to members in SNF and home settings. The responsibilities include but are not limited to: geriatric assessment, medical history, physical exam, diagnosis and treatment, development of the nursing plan of care, health education, physician referrals, case management referrals, follow-up and clear...

Job Requirements The Nurse Practitioner (NP) acts as part of the clinical operations team and is responsible for providing direct patient care in ChenMed/Dedicated medical centers. The responsibilities include but are not limited to: geriatric assessment, medical history, physical exam, diagnosis and treatment, development of the nursing plan of care, health education, physician referrals, case management referrals, follow-up and clear documentation according to ChenMed standards for quality, service, productivity and teamwork. It also includes the participation in clinical rounds and conferences plus in-depth documentation through written progress notes and summaries. The Nurse Practitioner must demonstrate the ability to function both independently and in collaboration with other health care professionals. Consults with the manager, physician, and medical director to ensure compliance with guidelines. This position may require participation in risk and quality management...

Description: JOB PURPOSE: Responsible for handling the instruments, supplies, and equipment necessary during the surgical procedure. He/she has an understanding of the procedure being performed and anticipates the needs of the surgeon. He/she has the necessary knowledge and ability to ensure quality patient care during the operative procedure and is constantly on vigil for maintenance of the sterile field. Functions in partnership with licensed staff. Performs patient care duties for clients of various age groups under the direction of a registered nurse. KEY RESPONSIBILITIES: 1. Functions as a member of the surgical team in the role of scrub person. a. Checks supplies and equipment needed for surgical procedure which includes review and utilization of appropriate preference card. b. Assists with room set-up to include opening of sterile supplies. c. Scrubs, gowns and gloves. d. Sets up sterile table with instruments, supplies, equipment and medication/solutions needed for...

Description: JOB PURPOSE: Responsible for handling the instruments, supplies, and equipment necessary during the surgical procedure. He/she has an understanding of the procedure being performed and anticipates the needs of the surgeon. He/she has the necessary knowledge and ability to ensure quality patient care during the operative procedure and is constantly on vigil for maintenance of the sterile field. Functions in partnership with licensed staff. Performs patient care duties for clients of various age groups under the direction of a registered nurse. KEY RESPONSIBILITIES: 1. Functions as a member of the surgical team in the role of scrub person. a. Checks supplies and equipment needed for surgical procedure which includes review and utilization of appropriate preference card. b. Assists with room set-up to include opening of sterile supplies. c. Scrubs, gowns and gloves. d. Sets up sterile table with instruments, supplies, equipment and medication/solutions needed for...

Description: JOB PURPOSE: Responsible for handling the instruments, supplies, and equipment necessary during the surgical procedure. He/she has an understanding of the procedure being performed and anticipates the needs of the surgeon. He/she has the necessary knowledge and ability to ensure quality patient care during the operative procedure and is constantly on vigil for maintenance of the sterile field. Functions in partnership with licensed staff. Performs patient care duties for clients of various age groups under the direction of a registered nurse. KEY RESPONSIBILITIES: 1. Functions as a member of the surgical team in the role of scrub person. a. Checks supplies and equipment needed for surgical procedure which includes review and utilization of appropriate preference card. b. Assists with room set-up to include opening of sterile supplies. c. Scrubs, gowns and gloves. d. Sets up sterile table with instruments, supplies, equipment and medication/solutions needed for...

Description: JOB PURPOSE: Responsible for handling the instruments, supplies, and equipment necessary during the surgical procedure. He/she has an understanding of the procedure being performed and anticipates the needs of the surgeon. He/she has the necessary knowledge and ability to ensure quality patient care during the operative procedure and is constantly on vigil for maintenance of the sterile field. Functions in partnership with licensed staff. Performs patient care duties for clients of various age groups under the direction of a registered nurse. KEY RESPONSIBILITIES: 1. Functions as a member of the surgical team in the role of scrub person. a. Checks supplies and equipment needed for surgical procedure which includes review and utilization of appropriate preference card. b. Assists with room set-up to include opening of sterile supplies. c. Scrubs, gowns and gloves. d. Sets up sterile table with instruments, supplies, equipment and medication/solutions needed for...

Summary A 20-bed Medical/Cardiac Telemetry Unit. The patient population varies with MS patients and cardiac overflow. Diagnoses include pneumonia, various lung disease, abdominal pain, infections, chest pain, post cardiac interventions. Job Description LOCATION : Lancaster, PA HOURS: Full Time (36 hours per week). Night Shift (7pm-7:30am). Rotating weekends and holidays. SIGN ON BONUS: Up to $15,000 (prorated based on FTE). 2-year commitment. Eligibility requirements apply including 15+ months of RN experience. POSITION SUMMARY: Assume responsibility and accountability as defined by the American Nurses Association standards of nursing practice. The Clinical Nurse 2 Colleague is an RN that practices as a full partner on the health care team and consistently demonstrates safe practice within the organizational professional practice model. The Clinical Nurse 2 Colleague possesses the knowledge, skills and the attitude to effectively meet standards for competent...