(RN) Quality Review Manager- Registered Nurse
$90k - $105kPersonal-Touch Home Care
Location: Brooklyn, NY Job Type: Full‑time, in‑person Pay: $90,000 - $105,000 annually About Us With over 50 years of dedicated service to our communities, Personal Touch has been a trusted provider of home care. Our priority lies in ensuring exemplary patient care while fostering a supportive and empowering workplace culture for all team members. We are currently seeking compassionate and skilled nurses to join our team and continue our legacy of providing personalized and attentive care to patients in the comfort of their own home. Why Choose Us Employee Recognition Programs: We acknowledge and celebrate your contributions. Comprehensive Health Benefits: We offer an inclusive package with Medical, Dental, Vision, Accident, and Long‑Term Disability Coverage to ensure access to quality medical care while promoting overall wellness. Generous Paid Time Off: We provide generous paid time off to ensure you can recharge and return to work refreshed, leading to greater productivity and job satisfaction. We support a healthy work‑life balance. Retirement Benefits: We offer a 401k plan to secure your financial future and help you save for retirement. Life Insurance: We offer company‑paid life insurance providing peace of mind and financial protection for you and your loved ones. Opportunities for Professional Growth and Development: Empowering you to thrive and grow. Employee Assistance Program: Supporting the well‑being of you and your family. Perks Program: Exclusive deals and offers on products, services, and experiences you need and love Job Details Overview As an RN Clinical Manager/ Quality Review Manager, you will play a pivotal role in coordinating and managing patient care to ensure the highest standards are met. This position involves supervising clinical personnel and ensuring the delivery of quality home care services. Responsibilities Receives case referrals. Reviews available patient information related to case, including disciplines required, to determine home care needs. Reviews each case by evaluating the services provided by clinicians, performs record review, instructs and guides clinicians to promote more effective performance and delivery of quality home care services and is always available during operating hours to assist clinicians as appropriate. Establishes patient’s clinical diagnosis according to referral documentation and coding guidelines, ensuring appropriate ICD‑10 Coding and sequencing as it relates to the patient’s medical condition including any comorbidities. Assists clinicians in establishing the POC including but not limited to medications review, ordered procedures/treatments, short and long‑term therapeutic goals. Oversight of all patient care services and personnel. Prospective review of OASIS assessments to include Start of Care, Resumption of Care, Recertification, Transfers, and Discharge to ensure appropriateness, completeness, and compliance with state and federal regulations. Consults with the appropriate clinician to clarify any issues and/or corrections to documentation; documents same in the medical record. Track any trends issues while reviewing OASIS documentation and alerts the DOE for additional training as needed. Directs case conference meetings with Organization personnel to facilitate coordination of care. Conducts quarterly record reviews and communicates findings and recommendations to appropriate Organization personnel. Assists in the orientation of new Organization personnel as requested. Assists Director of Education in the planning, implementation and evaluations of in‑service and continuing education programs. Performs direct patient care duties as appropriate. Complies with accepted professional standards and principles. Promotes customer service to all Organization personnel. Stays informed about changes in the field of home health care. Performs other duties and activities as delegated by the Administrator/Branch Director/Branch Manager. Performs all other duties as assigned. Qualifications Registered Nurse (RN) with current licensure to practice professional nursing in the State. Graduate of an accredited nursing school; BSN degree preferred. Two (2) years of prior home health care experience. At least one (1) year of management or supervisory experience in a health care setting, preferably home care. Demonstrates excellent observation, verbal and written communication skills. Verbal and written communication skills in English. We are excited to welcome passionate and dedicated individuals to join our team at Personal Touch Home Care. We’re more than just a company, we’re a close‑knit family dedicated to supporting each other’s success and well‑being. Apply now and join us in making a positive impact on the communities we serve. #J-18808-Ljbffr
$85k - $106.3k
...Overview Leads interdepartmental Quality Improvement (QI)... ...departments—including Care Management, Utilization Management, Provider... ...gaps. Performs clinical reviews with network providers to... ...to practice as a Registered Professional Nurse in New York State or New Jersey...SuggestedWork experience placementFlexible hours- ...health center in Bronx, NY is seeking an experienced Registered Nurse Manager to lead clinical staff and ensure high-quality patient care. The role includes duties such as... ...audits. Candidates must hold a BSN, a valid NY RN License, and have 3-5 years of relevant...SuggestedRelocation package
$90.13k - $112.66k
...New York is seeking a full-time Registered Nurse Manager. The role involves overseeing quality nursing care, patient education,... ...should have a BSN and 3-5 years of RN experience. Responsibilities... ...initiatives, and conducting performance reviews. This position offers a...SuggestedFull timeRelocation package$102.55k - $115.37k
...Position: RN Clinical Quality Manager Location: Hybrid (Must Reside in NY/NJ/CT) Work Schedule: Monday - Friday, 9:00am - 5:00pm Compensation:... ...improvement with HEDIS/Stars; 2 years direct hybrid record review. Strong metrics orientation, campaign management experience...SuggestedMonday to Friday$91.7k - $163.7k
...Position Overview Registered Nurse Manager – Gastroenterology – Lake Success, NY... ...Lead GI endoscopy team, ensure quality, staff supervision, and... ...and patient outcomes. Prepare RN schedules, plan unit staffing... ...for annual bonus and merit reviews. Equal Employment Opportunity...SuggestedTemporary workRelocation package- ...Quality Assurance Registered Nurse Supervisor Mercy Home for Children, a nonprofit agency... ...oversight to the LPN/RN nursing staff. To maintain... ...carried out by the staff. Manage notifications to proper authorities... ...and revised, as needed. Review appropriate documentation...Full timeWork experience placementWork at officeImmediate start
$27.02 - $48.55 per hour
...professional on our Medical Management/Health Services team.... ...hold an active New York State Registered Nurse (RN) licensure and be willing to... ...appropriate medical team to promote quality and cost effectiveness of... ...necessity and clinical reviews of authorization requests...Hourly payFull timePart timeWork at officeRemote workMonday to FridayFlexible hours$27.02 - $48.55 per hour
...Centene Corporation is looking for a clinical professional to join their Medical Management/Health Services team. This fully remote position requires active New York State RN licensure. You will analyze authorization requests for medical necessity, coordinate with healthcare...Hourly payRemote workFlexible hours- ...IntelliResume seeks a Clinical Review Nurse - Prior Authorization to analyze requests, determining... ...knowledge and experience in medical management. Strong candidates will have a degree... ...accredited nursing school and an active NY RN license. The role involves working...Remote work
- ...A healthcare organization is seeking a Clinical Review Nurse – Concurrent Review to perform utilization management functions remotely. The role requires conducting... ...collaborating with medical teams, and ensuring quality healthcare outcomes. Candidates should have an ADN...Work at officeRemote work
- ...professional on our Medical Management/Health Services team.... ...Performs concurrent reviews, including determining... ...level of care Reviews quality and continuity of care... ...Accredited School of Nursing or Bachelor’s degree... ...Preferred Qualifications RN‑Registered Nurse-State Licensure...Full timePart timeWork at officeRemote workFlexible hoursWeekend work
$27.02 - $48.55 per hour
...active New York State (NYS) RN licensure to be... ...Responsibilities Perform concurrent reviews, including determining... ...level of care. Review quality and continuity of care... ...records in health management systems according to... ...an accredited school of nursing or a Bachelor’s degree...Hourly payWork at officeRemote workMonday to FridayFlexible hours- ...Centene Corp. in New York is looking for a Clinical Review Nurse to perform concurrent reviews of member health and care. The position requires an active New York State RN license and at least 2 years of acute care experience. The role involves evaluating medical necessity...Remote workFlexible hours
$27.02 - $48.55 per hour
...IntelliResume is seeking a Clinical Review Nurse for a remote position in New York. This role involves performing concurrent reviews to assess members' health and contribute to discharge planning. Ideal candidates will have a BSN and 2+ years of acute care experience....Hourly payRemote workFlexible hours- ...Centene Management Company LLC in New York is seeking a Remote RN to perform concurrent reviews and support healthcare providers in delivering high-quality member care. The role requires an active New York... ...RN license and 2–4 years of nursing experience, preferably in...Remote workFlexible hours
$91.7k - $163.7k
Position Registered Nurse Manager - Gastroenterology Lake Success, NY (Locations: Syosset... ...potential, annual merit reviews, generous PTO, paid holidays,... ...more! About the Role The RN Manager will oversee the operational efficiency and quality of GI services, including direct...Full timeTemporary workLocal areaRelocation package- ...using HEDIS specifications for Quality Improvement and Corrective Action Plans • Review generic charts, and other... ...address them. • Engage Fund Registered Nurses (RN), Health Educators (HE) and Social... ...and projects as assigned by management Qualifications • Valid...Permanent employmentFull timeSeasonal workFlexible hoursAfternoon shift
- ...for a clinical professional to join their Medical Management/Health Services team. You will perform concurrent reviews to assess member health and the necessity of... ...ideal candidate will have a Bachelor's degree in Nursing (BSN) and at least 2 years of acute care experience...Remote work
$58 - $60 per hour
...Description NOW HIRING: Wellness QA Nurse Manager (RN) Midtown Manhattan, NY Full-Time... ...Wellness QA Nurse Manager (RN) to lead quality improvement initiatives, support... ...action initiatives using HEDIS measures Reviewing charts, audits, and population health data...Weekly payFull timeContract workImmediate start- ...Thyme Care is looking for a Team Lead, RN Quality Assurance to manage a team of quality reviewers. In this role, you will analyze quality trends, oversee audits, and support the ongoing development of nursing quality, ensuring the highest standards of care in oncology....
$55 per hour
...Our client, a clinical AI tool, is actively looking to hire medical education experts to serve as Panel Review Subject Matter Experts for an AI-powered learning platform supporting PA students in pre-clinical training. This advanced review role provides oversight and...Hourly payContract work- ...Hospital seeks a Supervisor for its Case Management Department. In this role, you will oversee... ...with case management and utilization review initiatives. Additionally, you will assist... ...s degree in a relevant field and a valid RN license in Florida. A minimum of 2 years’...Full time
- ...Ternium Revenue Cycle Management is seeking a full-time Remote Clinical Review Nurse to analyze denied insurance claims, draft appeal letters, and collaborate with... ...patient interaction. The ideal candidate will have an RN License and over 5 years of acute hospital...Full timeRemote work
- ...Job Description Beth Abraham Center is hiring a Registered Nurse (RN) Unit Manager in Bronx, NY. Responsibilities Handle all supervisory... ...Maintain the standards of care for the unit Review Resident records & quality of care Monitor overall care & review individual Residents...
$31 - $38 per hour
...coordinate wellness and disease management for members with chronic... ...with industry standards. Review gaps in care and medical and... ...established productivity, quality, and turnaround time standards... ...Graduate of an accredited Registered Nurse (RN) program with a current,...Hourly payRemote work- The Rawlings Group is seeking a Remote Medical Review Nurse II to perform medical claims audits. You will join a team assessing government and commercial claims. This role requires an active RN license and offers the chance to work collaboratively in a fast-paced environment...Remote job
$69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant, we... ...focus on what matter most - quality of care and healthier lives for... ...Experience with utilization management systems or clinical decision-... ...Active unrestricted RN license in good standing, is...For contractorsWork at officeRemote workWork from homeHome officeShift work- Machinify is seeking a Medical Review Nurse II to perform medical claims... ...This role requires an active RN license and at least 2 years... ...teams to ensure compliance and quality. Preferred qualifications... ...ICD-10 coding and utilization management systems. #J-18808-Ljbffr MachinifyRemote job
$69.3k - $78k
A healthcare payment integrity company is seeking a Medical Review Nurse II - Clinical Validation to perform medical claims audits for Government and Commercial Payers. The position requires an active RN license and a minimum of five years nursing experience. Responsibilities...Remote job$3,495 - $4,015 per week
...Health Services offers local and travel registered nurse and allied health opportunities.... ..., NY is seeking a Certified Case Manager Registered Nurse (CCM RN). Benefits Medical/Dental/Vision Insurance... ...in discharge planning, utilization review, as well as supervisory experience....Weekly payLocal area
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