Utilization Management RN CMS/NQCA Compliance
$77.6k - $126.1kFlorida Blue Group
Florida Blue Group is seeking a highly skilled Registered Nurse (RN) as a Utilization Management Compliance Specialist in New York. The role involves ensuring compliance with CMS and NQCA guidelines, evaluating risks, and implementing solutions for adherence to standards. Candidates should have over 5 years of experience and an active RN license. The position offers a salary range of $77,600 - $126,100 with comprehensive benefits including medical, dental, and retirement savings plans. #J-18808-Ljbffr
- ...GuideWell Mutual Holding Corporation in New York seeks a skilled Registered Nurse (RN) for the Utilization Management Compliance Specialist position. You will apply expertise in compliance, quality reporting, and risk management to ensure adherence to regulatory guidelines...CmsRemote work
$80k - $90k
...activity as assigned by management.* Monitors, tracks,... ...-harassment and other compliance and policy/procedures... ...and an understanding CMS, Medicaid and/or Commercial... ....* Experience with utilization management systems or... ...* Active unrestricted RN license #J-18808-Ljbffr...CmsRemote workFlexible hours- ...provides psychiatric evaluation, medication management, and ongoing treatment planning to... ...state and federal regulations, HRSA, CMS, grant compliance requirements and FoundCare Behavioral... ...FoundCare’s Behavioral Health Protocols. Utilize psychiatric progress notes to document...CmsWork at office
- ...family! Jump-start your career as an RN Case Manager Part Time today with HCA Florida Capital... ...optimal care and appropriate resource utilization. The RN CM Care Coordinator will... ...regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives; monitors...CmsPart timeWeekend work
$31.55 - $58.69 per hour
...and families in disease self‑management both during the hospital stay... ...improve the patient’s medication compliance. Coordinate care of patients... ..., and Abilities Ability to utilize the nursing process (... ...Certifications Registered Nurse (RN) [Required] Basic Life Support...CmsFull timeWork experience placementLocal areaShift work$83.1k - $120.36k
...Clinical Peer Reviewer (Phyiscal Therapy) Utilization Management (UM) plays a critical role in... ...business while maintaining regulatory compliance and supporting optimal functional outcomes... ...internal turnaround timeframes and meet CMS, NYS DOH, and Healthfirst standards....CmsWork experience placement$32.76 - $57.47 per hour
...skills [Required] Ability to manage multiple tasks and prioritize... ...discharge [Required] Knowledge of CMS Conditions of Participation... ...] Prior Care Management/Utilization Management experience [Preferred... ...Certifications: Registered Nurse (RN) [Required] Basic Life...CmsPart timeWork experience placementLocal areaFlexible hoursShift workWeekend work$33.99 - $63.22 per hour
...reporting methodologies. Utilizes process improvement... ...consistency and ensure compliance with all relevant government... ...requirements (IPPS, CMS, OIG) to support compliance... ...field such as nursing, management, business [Required]... ...Experience 3+ as an rn in an acute clinical setting...CmsFull timeWork experience placementLocal areaShift work$85.53k - $159.09k
...: Oversees the team's utilization of technology and adherence... ...post‑acute settings. Manages daily operations of the... ...to monitor staff compliance with documentation and... ...Management principles and CMS Conditions of Participation... ...: Registered Nurse (RN) [Required] Accredited...CmsFull timeWork experience placementLocal areaShift work$73.1k - $142.55k
...evaluation and support, and ensuring compliance with regulatory and internal... ...member care. The Program Manager plans and executes internal... ...more of the following areas: utilization management, care management,... .... Registered Nurse (RN), Licensed Vocational Nurse (...CmsContract workWork experience placementWork at office- ...Clinical Appeals Nurse (RN) Status: Exempt Location: Remote... ...reimbursement outcomes, and ensuring compliance with payer policies and... ...Prior experience in utilization review, case management, CDI, or clinical appeals Familiarity with CMS guidelines, InterQual, Milliman...CmsRemote work
$25k
...The Clinical Care Nurse (RN) is a clinic-based nursing... ...), reduce avoidable ED utilization, and drive Medicare Advantage... ...in chronic disease self‑management, particularly in DM, HTN,... ...accurately and in compliance with organizational and CMS regulatory standards. Prepare...CmsTemporary workApprenticeshipWork at officeMonday to Friday$97.59k - $168.34k
...our team as a Senior Business Manager - Radiology. The Business... ...cycle performance, resource utilization, equipment purchasing, and budget... ...ancillary services, ensuring compliance with institutional policies,... ...requirements (e.g., Joint Commission, CMS) Excellent communication,...Cms- ...measurement and assessment. Implement Joint Commission, CMS, State, rehabilitation nursing, and hospital standards. Utilize a staffing matrix that factors in patient acuity... ...plans that optimize health, promote wellness, manage illness, and prevent patient complications....CmsShift workDay shift
- Position Purpose The Branch Manager leads branch operations to deliver exceptional customer... ...a culture of excellence and ensuring compliance and safety standards, the Branch Manager... ...organizational resilience. Experience in effectively utilizing digital tools and platforms for...CmsBi-weekly payWeekly payTemporary workWork at officeLocal areaFlexible hours
$72k - $81k
...Scope The Case Manager manages an individual caseload using the case management process in order to meet the needs of the MedWatch, LLC customers and consumers. This includes, but is not limited to, authorization of services, review of treatment plans for medical necessity...CmsTemporary workWork at officeRemote workWork from homeHome office$39 - $41 per hour
...Description: Position Title: RN House Supervisor Department: Skilled... ...accurate documentation and compliance with facility policies,... ...communication skills, and the ability to manage multiple priorities while... ...infection control standards, CMS guidelines, and survey readiness...CmsHourly payPart timeMonday to FridayShift workWeekend workAfternoon shiftWeekday work- ...clients and Corcoran Sunshine Accounting to manage multiple installment payment schedules... ...installment payments to ensure accuracy, compliance, and timeliness across all assigned projects... ...services. Strong understanding of CMS functionality and multi‑project portfolio...CmsWork at office
$71.1k - $97.8k
Quality Improvement RN - New Smyrna/Daytona 3 days ago Be among... ...following areas: Quality/clinical management and population health HEDIS... ...knowledge of HEDIS/Stars/CMS Excellent presentation and communication... ...take affirmative action, in compliance with Section 503 of the...CmsTemporary workApprenticeshipWork experience placementInternshipWork at officeLocal areaMonday to FridayFlexible hours- CORE JOB SUMMARY The Director of Quality, Compliance & Risk Management is responsible for leading, implementing, and overseeing HealthyMD’s organization... ...with accreditation and oversight standards (e.g., HRSA, CMS, Joint Commission, and other applicable agencies)....CmsLocal area
$71.1k - $97.8k
A leading health insurance company is seeking a Utilization Management Registered Nurse to utilize clinical nursing skills for coordinating medical... ...remote position requires clinical experience and a Compact RN license. Responsibilities include making care determinations,...Remote job$68.6k - $91k
...As the Catering Planning Resource Manager, you will ensure that Hourly Cast Members are scheduled efficiently and effectively in order... ...to ensure up-to-date daily and weekly forecasts and accuracy in CMs schedules. Ensure sufficient labor resources are available to meet...CmsHourly payFull timeTemporary workWork experience placementLocal areaShift work- ...resources for our partner organizations. By managing a network of advanced practice providers... ...program oversight, ensuring consistency, compliance, and continuous improvement across teams... ...chart audits to ensure adherence to CMS guidelines and internal standards Support...CmsFull time
$29.1 - $62.32 per hour
4062 Aetna Resources, LLC is seeking a Utilization Management Nurse Consultant Clinical Precertification RN (Medicare) to support healthcare quality and care coordination. This full-time remote position requires an active RN license and at least 3 years of RN experience...Remote jobHourly payFull time- ...requires extensive experience in coding accuracy, regulatory compliance, and reimbursement processes for both inpatient and outpatient... ...candidate will thrive in a fast-paced environment and is skilled in utilizing ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding systems. Strong...CmsFull timeRemote work
- ...Expedition The Medical Case Manager is a Licensed Practical Nurse... ...adhering to HIPAA and/or GDPR compliance. The Medical Case Manager (UR... ...regard to medical-surgical cases, utilization management, discharge... ...health professionals: LPN or RN. Active license in the state...CmsTemporary workInternshipWork at officeLocal areaImmediate startWork from home2 days per week3 days per week
$20.6 per hour
...training, supporting clinical teams, and maintaining compliance with hospital policies, Joint Commission standards, EMTALA, CMS requirements, and site‑specific procedures.... ...hospital leadership, the security account manager, and frontline officers—promoting safety, service...CmsPart timeWork at officeLocal areaImmediate startShift workNight shift$96k - $192k
Role Overview The Manager, Marketing Operations supports the Director in building a high‑performing... ...and operational best practices. Ensure compliance with privacy, data governance, and... ..., CRM, marketing automation platforms, CMS, and analytics tools. Demonstrated ability...CmsTemporary work£58k - £70k per year
...of our customers in the dark. Join us as a Business Continuity Manager and find your superpower. National Grid is hiring a Business... ...working closely with business stakeholders to ensure program compliance and provide support to the business as a BCM expert. As part...CmsWork at officeLocal areaFlexible hours2 days per week1 day per week- ...Your Role As Marketing Operations & Systems Manager, your role includes supporting the... ...personal or banking information. Regulatory Compliance & Background Screening Discovery Senior Living... ...under federal programs, including CMS, Medicare, and Medicaid regulations, as well...CmsLocal areaFlexible hours
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