Registered Nurse - Utilization Review / Quality Improvement
WhiteCap Search
Whitecap Search Healthcare Partners is seeking a dedicated RN for a Utilization Review & Quality Improvement role at a community hospital. This position focuses on utilization review responsibilities, working closely with physicians to analyze patient readiness for discharge and manage patient load. Function Whitecap Search Healthcare Partners is seeking a dedicated RN for a Utilization Review & Quality Improvement role at a community hospital. This position focuses on utilization review responsibilities, working closely with physicians to analyze patient readiness for discharge and manage patient load. Function The role is heavily focused on Utilization Review (UR) responsibilities, utilizing MCG and Interqual criteria. The RN will review charts, manage patient loads, and collaborate with physicians to determine patient discharge readiness. The team comprises six other UR RNs, and the position reports to the COO. Requirements BSN NY RN License 5 years of UR experience Hospital experience is required Schedule & Compensation The position follows a 4x10 schedule with no remote flexibility. As a union position, there is potential for increases available through differentials based on specific criteria. #INCO Disclosure: The hourly rates and/or salaries listed may or may not reflect total compensation packages including bonus and fringe benefits, etc., nor are the advertisement(s) posted a guarantee of a certain compensation package for a position or bona fide offer of employment. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability. #J-18808-Ljbffr WhiteCap Search
- Whitecap Search Healthcare Partners is seeking a dedicated RN for a Utilization Review & Quality Improvement role at a community hospital. This position focuses on utilization review responsibilities, working closely with physicians to analyze patient readiness for discharge...Quality
- ...physicians, surgeons, nurses, pharmacists and... ...Summary and Purpose The Utilization Review RN performs activities... ...Licensure: Active Kentucky Registered Nurse License or... ...situations, process improvements, evidence-based practice... ...Ensuring the highest quality of care for those we...QualityWork at officeShift work
$35 - $43 per hour
...43.00/hr Job Title Clinical Review Nurse - Concurrent Review Location... ...Concurrent Review will perform utilization management functions to... ...day while maintaining high-quality standards. Manage and document... ...recommendations for process improvement. Provide subject matter expertise...QualityRemote work$34 - $40 per hour
...Medix is seeking an experienced Utilization Review Nurse to support our mission of improving patient care through home-based... ...internal teams to deliver high-quality, cost-effective care. What You’... ...50-$47.59 1 day ago Telehealth Registered Nurse- REMOTE September 2025...QualityFull timeRemote work$26.01 - $56.14 per hour
...solutions that promote high-quality healthcare for members. Position... ...medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, you’ll play a vital role in... ...tests, and implements process improvements, new audit concepts,...QualityRemote jobHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hoursShift work$85k - $106.3k
...Leads interdepartmental Quality Improvement (QI) initiatives focused... ...including Care Management, Utilization Management, Provider Relations... .... Performs clinical reviews with network providers to... ...to practice as a Registered Professional Nurse in New York State or New...QualityWork experience placementFlexible hours3 days per week- ...Conduct telephonic clinical reviews • Complete PRI & Screen assessments... ...with Care Coordination, Utilization review and discharge... ...of clinical experience as a Registered Nurse. -Experience with Care Coordination... ...in attaining the highest quality talent in the marketplace....Quality
- ...dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our... ...and outpatient utilization reviews while supporting... ...appropriate, timely, and high-quality services. The ideal candidate... .... Contribute to process improvement initiatives to enhance overall...QualityRemote work
- ...Job Summary and Responsibilities As our Utilization Management Nurse, you will be a critical guardian of healthcare efficiency and quality, ensuring integrity in clinical decision‑... ...utilization. Every day, you will meticulously review medical records, authorize services, and...Quality
- A healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare... .... This contract role offers a chance to manage healthcare quality efficiently while working remotely. #J-18808-Ljbffr...QualityRemote jobContract work
$92.3k - $120k
Registered Nurse (RN), Home Health Utilization Management Remote - USA At Clover Health, we are... ...to providing high-quality, affordable, and easy-to... ...transitions. Responsibilities Review Home Health prior... ...Participate in quality improvement initiatives, calibration...QualityWork at officeLocal areaRemote workFlexible hours- ...Position Overview: We are seeking a skilled and detail-oriented Utilization Review RN with a valid PA license (or Compact)to join our team.... ...healthcare providers and insurance partners to ensure efficient, quality patient care Document review findings accurately and in a...QualityFull timeContract workRemote work
$35 - $45 per hour
...the job poster from IntePros IntePros is seeking a Remote Utilization Review Nurse serves as a key clinical liaison, coordinating resources and... .... Monitor patient progress and outcomes to support quality and cost‑effective care delivery. Provide responsive customer...QualityContract workRemote workWeekend work$65 per hour
Job Title: Registered Nurse (RN) - Case Management Location: New York, NY 10... ...resources, and ensure appropriate utilization of healthcare services while maintaining high-quality patient outcomes. Key... ...planning. Conduct utilization review to ensure appropriate level of...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$18k
...Regional Medical Center has focused on quality patient care and service to the community... ...the communities we serve. Our doctors, nurses, and allied health professionals are a... ...-based concurrent and retrospective utilization review to support and encourage the efficient...QualityFull timePart timeLive out- Martin's Point Health Care is hiring a HEDIS Nurse Reviewer to perform clinical data reviews and ensure HEDIS compliance. The role requires nursing expertise and experience in quality improvement, with collaboration across care teams and physicians. Responsibilities include...Quality
- ...Quality Assurance & Improvement Specialist The Emma L. Bowen Community Service Center is seeking a Quality... ...Duties and Responsibilities: Review client medical records to identify... ...professional development opportunities. Utilize electronic health record (EHR)...QualityFull time
- Enlyte is seeking a qualified Utilization Reviewer who can work remotely from home. The ideal candidate performs utilization review on... ...and claims adjusters, and staying current with industry regulations and best practices to improve review quality. #J-18808-LjbffrQualityRemote workWork from home
- ...Overview Quality Improvement Specialist A nationally recognized comprehensive Health and Human... ...readiness for internal and external audits/reviews. In addition, the QA Analyst will be... .... Conducts timely scheduled/required utilization reviews for assigned agency sites Reviews...QualityRemote work3 days per week
$42 per hour
...population health, and utilization management. IntusCare empowers... ...their operations and improve outcomes for dual-... ...Utilization Management Nurse plays a critical role in ensuring high-quality, cost-effective, and compliant... ...provider networks to review service utilization,...QualityContract workRemote work- ...All Jobs Quality Assurance & Improvement Specialist Quality Assurance & Improvement Specialist - Hybrid... ...Essential Duties and Responsibilities: Review client medical records to identify documentation... ...development opportunities. Utilize electronic health record (EHR)...QualityFull timeWork experience placementRemote work
$60.2k - $107.4k
...our team will directly improve health outcomes by... ...Connecting. Growing together. Utilization Management & Clinical... ...and efficiently review and extract pertinent... ...opportunities. The Appeals nurse will perform their job... ...as needed Adheres to quality and productivity...QualityMinimum wageFull timeWork experience placementLocal areaRemote work$85k - $106.3k
...Behavioral Health-focused Quality Improvement Specialist to lead... ...performance gaps. Perform clinical reviews with network providers to... ...methodology. Perform utilization and quality assessment reviews... ...to practice as a Registered Professional Nurse, LCSW, LMFT, LMHC, LPC, or...QualityWork experience placementFlexible hours$118.4k - $219k
...Position Purpose: Lead and direct process improvement initiatives by utilizing process improvement methodologies in... ..., coordination and evaluation of quality assurance and training, including... ...Commission Accreditation standards. Review and implement new technological tools...QualityFull timePart timeWork at officeRemote workWork from homeFlexible hours- ...responsibility, integrity, quality and trust that are... ...Applies approved utilization criteria to monitor appropriateness... ...and continued stay review. Communication to... ...as determined by nursing judgment and/or collaboration... ...to practice as a Registered Nurse in the State of...QualityWork at officeShift workNight shiftRotating shift
- ...Systems in Becker’s Hospital Review, Geisinger is focused on creating a national model for improving health. The RN Performance... ...Improvement Coordinator evaluates the quality of health care rendered by... .... Qualifications Registered Nurse (RN) Licensed in Pennsylvania...QualityTemporary workShift work
- ...a national model for improving health. Today, we’re focused... ...professional growth, quality improvement, and... ...innovative culture that allows nurses to grow their... ...and team members on the review functions within the CDI... .... Licensed Registered Nurse in Pennsylvania....QualityFull timePart timeMonday to Friday
- Clover Health is hiring a Registered Nurse (RN) for Home Health Utilization Management. This remote role supports CMS-guided reviews, medical necessity determinations,... ...regulatory compliance, and continuous improvement, while delivering high-quality outcomes for members in a...QualityRemote job
$27.02 - $48.55 per hour
...active New York State Registered Nurse (RN) licensure and be... ...Performs concurrent reviews, including determining... ...of care Reviews quality and continuity of care... ...systems according to utilization management policies and... ...on opportunities to improve appropriate level of...QualityHourly payFull timePart timeWork at officeRemote workFlexible hours
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