Utilization Quality Review & Education Specialist - Home Care
Mohawk Valley Health System
Mohawk Valley Health System in New York, NY, is seeking a Quality Improvement Reviewer/Educator for a full-time day position. This role involves developing, implementing, and evaluating quality improvement practices in Home Care Services. Responsibilities include conducting audits, preparing reports, and educating clinical staff on compliance and quality improvement standards. Candidates should have an associate's degree in applied science and a current NYS registered nursing license along with at least 1 year of home care experience. #J-18808-Ljbffr Mohawk Valley Health System
$35 - $45 per hour
...IntePros is seeking a Remote Utilization Review Nurse serves as a key clinical... ...across teams to optimize care, drive cost‑effective resource... ...determine the need for continued home health services in alignment... ...and outcomes to support quality and cost‑effective care delivery...QualityContract workRemote workWeekend work$34 - $40 per hour
...About the Role Medix is seeking an experienced Utilization Review Nurse to support our mission of improving patient care through home-based health services. In this role, you... ...payers, and internal teams to deliver high-quality, cost-effective care. What You’ll Do...QualityFull timeRemote work- Title: EDUCATIONAL/VOCATIONAL SPECIALIST Reports to: Director of Social Services... ...external partners. Utilize Sanctuary Model... ..., and red flag reviews—to foster a trauma-informed... ...practice to ensure quality care. Coordinate with... ...Must be able to make home visits, escort youth...QualityFull timePart timeFor subcontractorInternshipMonday to FridayFlexible hoursNight shift2 days per week
- ...healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources,... ...have experience in utilization review or home health. This contract role offers a chance to manage healthcare quality efficiently while working remotely. #J-1880...QualityContract workRemote work
- ...A healthcare staffing firm is seeking a skilled Utilization Review RN to join their team. This fully remote position requires a valid PA RN license and prior experience in insurance utilization review. Responsibilities include conducting clinical reviews, applying evidence...QualityRemote work
- ...States is hiring for a Concurrent Review Nurse responsible for performing utilization management activities remotely. The... ...to ensure appropriate patient care. The ideal candidate will be a registered... ...with regulatory standards and quality improvement initiatives. #J-18808-...QualityRemote work
- ...management organization is seeking experienced Physician Reviewers to join their Medicare Utilization Management team in a remote position.... ...evidence-based guidelines, and collaborating to ensure quality care for members. Candidates must be board-certified physicians...QualityRemote work
- ...Village Center for Care, Inc. is seeking a self-motivated RN for the role of Utilization Review Nurse in a full-time, hybrid position located in the New York Tri-State... ...for assessing member needs and ensuring high-quality health care services. Key qualifications include...QualityFull timeRemote work
- ...Martin's Point Health Care Inc. is looking for a Utilization Review Nurse in New York. This role requires a strong background in clinical nursing and utilization management to ensure quality, cost‑efficient medical outcomes. Responsibilities include reviewing prior authorization...QualityRemote work
- ...A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates... ...ensuring high standards of patient care. Responsibilities include... ...opportunity to work from home while contributing to quality medical reviews. #J-18808-Ljbffr...QualityFull timeRemote workWork from home
$93.4k - $116.8k
...with a strong background in Quality including quality of care reviews, incident investigation,... ...quality assurance and utilization review activities with interdisciplinary... .... Collaborates with Education department in the... ...of the largest nonprofit home- and community-based...QualityWork experience placementRemote workFlexible hours- ...Street, a nationally recognized Independent Review Organization (IRO), is expanding its... ...Compensation Board Certification to conduct Utilization Reviews. This is a fully remote, non-... ...practicing physicians to ensure high-quality, evidence-based clinical decisions that...QualityPrice workExtra incomeFor contractorsRemote workFlexible hours
$45k - $70k
...A leading healthcare company in the United States is looking for a Utilization Management Nurse Reviewer to ensure the efficient use of medical services and provide clinical expertise. Applicants must have an active LVN/RN license, with a preference for candidates having...QualityRemote work- ...is offering a remote internship for a Utilization Management Behavioral Health... ...Medicaid team, focusing on clinical reviews and patient care. Candidates must be transitioning military... ...clinical reviews, documentation, and quality assurance. The position operates weekdays...QualityInternshipWork at officeRemote workWeekday work
- ...Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications... ...A confidential managed care organization is seeking a... ...DUR) Pharmacist to support quality prescribing and improve patient... ...What You'll Bring Education: Doctor of Pharmacy (PharmD...QualityRemote work
- ...in healthcare is seeking a dedicated Utilization Review Nurse to join their team. This role... ...ensure efficient resource use and high-quality patient care. You will collaborate with clinical... ...values its employees and offers an Education Benefit program to support your...Quality
$135 - $150 per hour
...Job Posting: Medical Director (Utilization Review / Peer-to-Peer) Location: Position is... ...receiving the most appropriate, high-quality, and cost-effective care. You will serve as a vital... ...URAC). Qualifications & Requirements Education & Licensure: MD or DO degree from...QualityHourly payFull timeContract workRemote work$95 - $96 per hour
...Specialty Services, Inc is looking for a Family Medicine Physician specializing in imaging case reviews and appeals. This role requires a commitment to quality patient care and utilization management, ensuring compliance with URAC and NCQA standards. The ideal candidate will...QualityHourly pay- ...healthcare provider in New Jersey is seeking a Quality Management Nurse to oversee patient care quality. This role involves reviewing patient records for treatment... ...license, and experience in clinical nursing or utilization review. The position offers competitive compensation...Quality
- ...Quality Assurance Manager – Home Care Agency Brooklyn, NY | Full-Time | Competitive Salary + Benefits This is not a remote position... ..., caregiver documentation, and EVV compliance. Utilize the HHA Exchange platform to review, track, and improve operational and quality metrics...QualityFull timeWork at office
- ...seeking a Physician to provide utilization review services for the Group... ...contributions every day. We care for our customers, each other... ...date and time. Assist with quality assurance of reports prior to... ...and based on business needs. EDUCATION/CREDENTIALS: Board Certified...Quality
$35 - $43 per hour
.../hr Job Title Clinical Review Nurse – Concurrent Review... ...Review will perform utilization management functions to... ...members receive the right care at the right time. This... ...while maintaining high-quality standards. Manage and... ...health management systems. Educate providers on...QualityRemote work- ...Utilization Review Nurse VillageCare is looking for a self-motivated... ...the comfort of your own home as you will be... ...solutions that promote high quality and cost effective health care services. Some of your daily... ...Dental/Vision, HRA/FSA, Education Reimbursement,...QualityFull timeWork from home
- ...community hospital in Arizona is seeking a Utilization Management Nurse to ensure healthcare efficiency and quality through diligent review of medical records and adept communication... ...us in providing comprehensive patient care in a supportive environment. #J-18808-Ljbffr...Quality
- A healthcare solutions company is seeking a Utilization Management Nurse Reviewer to assess the appropriateness of medical services and collaborate with healthcare professionals. This role requires a Licensed Practical/Vocational Nurse with clinical experience and skills...Quality
- ...golden thread” of compassionate care that connects staff and... ...and Responsibilities As our Utilization Management Nurse, you will be... ...of healthcare efficiency and quality, ensuring integrity in clinical... ...Every day, you will meticulously review medical records, authorize...Quality
$65 per hour
...will coordinate patient care, manage resources, and ensure appropriate utilization of healthcare services while maintaining high-quality patient outcomes. Key Responsibilities... .... Conduct utilization review to ensure appropriate... ...legal support, auto and home insurance, pet insurance...QualityHourly payWeekly payLocal areaShift work$45 - $50 per hour
Greenlife Healthcare Staffing is looking for a dedicated Registered Nurse Clinical Reviewer for a fully remote position in New York. This role involves conducting utilization and quality reviews and contributing to clinical studies. With a competitive pay of $45 - $50 per...QualityRemote jobHourly pay$90k - $105k
...has been a trusted provider of home care. Our priority lies in... ...Coverage to ensure access to quality medical care while promoting... ...RN Clinical Manager/ Quality Review Manager, you will play a pivotal... ...requested. Assists Director of Education in the planning, implementation...QualityFull timeTemporary work$18k
...Regional Medical Center has focused on quality patient care and service to the community. As the... ...-based concurrent and retrospective utilization review to support and encourage the... ...regulations and provide information and education to clinical care providers in order...QualityFull timePart timeLive out
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