RN II: Utilization Management & Clinical Quality Audits
L.A. Care Health Plan
L.A. Care Health Plan is seeking an experienced Utilization Management Clinical Quality Nurse Reviewer RN II to lead audits, ensure regulatory compliance, and support policy development. The role emphasizes data analysis, reporting, and collaboration with Compliance and UM leadership. The RN must have strong documentation skills, CA RN license, and extensive experience with Medi-Cal/Medicare in managed care. This on-site role offers growth opportunities within the UM department. #J-18808-Ljbffr L.A. Care Health Plan
$69.3k - $78k
...Medical Review Nurse II - Clinical Validation At Performant... ...what matter most - quality of care and healthier... ...medical claims audit reviews. As a MR Nurse... ...Needed Experience with utilization management systems or clinical decision... ...Active unrestricted RN license in good...QualityFor contractorsWork at officeRemote workWork from homeHome officeShift work- ...This job applies clinical expertise as well as knowledge of utilization and discharge planning... ...via the regulatory audit process. Identifies... ...adversely impact quality patient care, appropriate... ...Vice President/Manager of Regulatory... ...patient care as an RN. Experience in Case...QualityRemote jobFull timeWork experience placementLocal areaImmediate startFlexible hoursWeekend work
$62.7k
...related to the potential of quality medical care and... ...Perform special studies per audits, conducting office site... ...Develop and manage process improvement initiatives... ...Required ~ Current state RN or LPN license or... ...understand and interpret clinical data Language (Other...QualityFor contractorsWork at officeLocal areaRemote work$98k - $115k
...Position Summary The Clinical Care Coordinator II is part of a collaborative... ...wound care and pain management. Round independently... .... Maintains and utilizes monthly team budget to... ...and the quality of patient outcomes.... ...unrestricted New York State RN license. Preferred Qualifications...QualityTemporary workWork at officeLocal area- ...Job Title: Utilization Management Registered Nurse (UM RN) – SNF / MLTC Location: Remote (Must reside in NY, NJ... ...In this role, you will evaluate clinical documentation, assess medical necessity... ...continued stay determinations. Quality & Appeals: Identify potential...QualityFull timeRemote workMonday to Friday
$34 - $35 per hour
Utilization Management - Clinical Nurse - Work from Home! Utilization Management - Clinical Nurse - Work from... ...providers and facilities to promote quality service and care Screen and identify... ...rater reliability reviews Qualifications RN license in an eNLC (Enhanced Nurse...QualityFull timeWork at officeRemote workWork from homeNight shift- Iterative Health is seeking a Clinical Research Coordinator II to independently coordinate daily study activities across GI, hepatology, obesity, and... ..., and internal teams to drive patient recruitment, data quality, and regulatory readiness while maintaining CTMS/EDC...Quality
$64k - $93k
...circumstances. Job Summary The Clinical Auditor I performs... ..., retrospective chart audit review, comparing... ...group, including management, physicians, clinical... ...paid claims, the auditor utilizes the WellSense policies... ...Identifies potential quality of care or utilization...QualityFull timeContract workWork at officeRemote workFlexible hours$35 - $37 per hour
...Title: Remote Registered Nurse (RN) - Temp to Perm Pay Rate: $36-3... ...be responsible for completing quality audits of physician case reviews, supporting the clinical aspects of the review process,... ...NPs, whether practicing or not. Utilization Review experience is helpful but...QualityRemote jobPermanent employmentFull timeTemporary workMonday to Friday$31 - $35 per hour
Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a critical role in supporting utilization management operations by conducting medical necessity reviews, preparing... ...documentation, you will help support high-quality care, regulatory compliance,...QualityFull timeRemote workFlexible hoursShift work- ...the region's leader in providing progressive, quality patient care with significant investments in our... ...*40**Position Overview**Performs a variety of utilization and resource management activities to promote quality, clinical and cost effective outcomes. Assesses patients...QualityFull timeTemporary workPart timeWork at officeLocal areaImmediate startFlexible hoursNight shift
$2,131 per week
...Registered Nurse (RN) | Outpatient Clinic Location: New York, NY Agency: FlexCare Pay... ...nursing, allied health, and therapy talent management solutions for top healthcare... ...clinicians with the right facilities to deliver quality patient care 31006574EXPPLAT...QualityFull timeContract workLocal areaImmediate startShift work$63.1k - $94.65k
...enabled revenue cycle management solutions for health systems... ...have current compact RN license, or be willing... ...are seeking Virtual Utilization Review Specialist with... .... Utilizes approved clinical review criteria to... ...Monitor for readmissions Quality/Revenue Integrity...QualityTemporary workWork at officeLocal areaRemote workMonday to FridayShift work- ...Corporation is hiring a Nurse Liaison I for Utilization Management & Quality Review. This remote nationwide role supports clinical review activities, benefit determinations and... ...coverage decisions. The position requires an RN with an unrestricted license, 3 years of clinical...QualityRemote job
$45 - $50 per hour
...looking for a dedicated Registered Nurse Clinical Reviewer for a fully remote position in... ...York. This role involves conducting utilization and quality reviews and contributing to clinical studies... ...programs with an active New York RN license. #J-18808-Ljbffr kozmetickesluzby...QualityRemote jobHourly pay- ...Health With eight hospitals and over 180 clinics, we are the region’s largest... ...throughout the region. Organization Utilization Management Job Summary Facilitates optimal reimbursement... ...University Medical Center’s mission of quality in patient care, education and...QualityRemote jobTemporary workWork experience placementLive outFlexible hours
- Healthfirst in New York City area seeks a Manager of Utilization Management to oversee case management teams, ensuring high-quality, cost-effective utilization of member services... ...staff. The role requires an Associate’s degree (RN/LPN license and Master’s degree preferred),...Quality
- At Cleveland Clinic Health System, we believe in a better future for healthcare. And... ...and The Power of Every One. Job Title Utilization Management RN Reviewer Location Cleveland Facility... ...Remote Location Department Utilization And Quality Assur-Weston Hospital Job Code 000446...QualityFull timeWork at officeRemote workShift workWeekend work
$43.07 per hour
...health and enjoy the best quality of life possible. What you’... ...Under the direction of the Clinical Nurse Supervisor, Operational Manager, and Medical Director/Chief; The RN Team Leader provides unit-level... ...recommendations about the utilization of property and supplies to...Quality- EXL Service is seeking a CVA Quality Manager to lead the planning, coordination, and execution of Clinical Validation Audit quality review activities. You will manage a team of CVA quality analysts and collaborate cross-functionally to meet quality standards, client SLAs...QualityRemote job
$114k - $143k
RN Clinical Care Manager/Case Manager - New York Position Summary: The RN Clinical Care Manager/Case... ...Serve as Healthmap member advocate, utilize community resources and programs, and... ...healthcare services, clinical operations, quality, or care management 3 years of experience...QualityTemporary workWork at officeLocal area- ...Brooklyn and Queens, Inc. seeks a Residence Supervisor to oversee clinical, residential, and program operations in its NY housing programs. You will supervise staff, ensure quality care, and maintain audit readiness while coordinating with facility teams across shifts....QualityShift work
- CareSource is seeking a Clinical Care Reviewer II with RN licensure and Compact or MA license eligibility to support medical necessity reviews and discharge planning. You will coordinate care, engage partners, and assist with transitions to appropriate care levels while...
$115.49k - $192.33k
...Job Description Description The Clinical Program Manager is responsible for assuring compliance with mandated clinical orientation, competency... ...MSMC Departments, Administrators, Nursing, Medical and Quality Leadership, and Clinical Staff, managing the educational and...QualityFull timeTemporary workTraineeshipLocal area$36.8 - $49.8 per hour
...better. As a member of the Clinical Services team, our Utilization Management Nurses provide... ...healthcare needs and to promote quality and cost-effective... ...management, disease management, auditing or retrospective review... ...field (psychiatric RN or Masters’ degree in Behavioral...QualityFull timeWork at officeImmediate startWork from homeFlexible hours$275k - $315k
...Title: Medical Director of Utilization Management Summary: Step into a... ...leadership position as the Clinical Lead for a prominent Health... ...oversee clinical strategy, quality improvement, and cost-effectiveness... ...for State/Federal audits. Propose annual goals and...QualityFull timeWork at officeRemote workMonday to FridayShift work2 days per week$57 - $61 per hour
...area is seeking an experienced Registered Nurse (Clinical Care Manager) to lead care coordination and clinical quality in a community-based setting. The ideal candidate... ...years of clinical management experience, a valid RN license in New York, and strong EMR and UAS assessment...QualityHourly payMonday to Friday- Community Care is seeking a Registered Nurse to perform utilization review and coordinate care for members across the health care continuum... ...services, communicate findings to providers, and participate in quality improvement initiatives. #J-18808-Ljbffr Community CareQuality
- Cambia Health Solutions is seeking a Utilization Management Nurse to join the Clinical Services team. You will perform... ...ensure medical necessity and promote quality, cost-effective outcomes for... .... The position requires an active RN license, 3 years in case or utilization...QualityRemote job
- nirvanaHealth is seeking a part-time Utilization Management (UM) Nurse to join our remote team. The UM Nurse will perform prospective... ...determine level of care, and participate in initial clinical review to ensure high-quality, cost-efficient care within regulatory standards....QualityRemote jobPart timeWeekend workAfternoon shift
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