54 rn auditor utilization management jobs found

Job Description: The RN Clinical Data and Audit Nurse is responsible for the clinical content component of all data collection, audit activities, and utilization review to ensure high quality for all delegated contracted health plans. Provides utilization review and completion of authorization requests for contracted delegated health plans. The authorization requests include prior authorization, retro authorizations, inpatient authorizations, and skilled nursing authorizations, along with providing concurrent review and care coordination with discharge planning when needed. Collaborates with the Medical Director, management, clinical staff, and Health Plan staff to manage health plan-specific data, reports, and audits into a centralized data file, ensuring accuracy and accessibility to appropriate staff, along with utilization review. Provides data analysis regarding patient level and aggregate utilization and trend reports for each plan. Assists with evaluating plan utilization...

Clinical Document Integrity Lead (RN) - Pediatric (Remote within Florida) | HIM Revenue Cycle | Day | Full-Time Overview Supervises and coordinates CDI workflow and provides leadership to assure section goals are met. Assists CDI Quality Auditor with orientation and training of CDI staff. Coaches and assists CDI Specialists in regards to collaborating with medical staff on the integrity of medical record documentation pertaining to compliance and coding requirements. Reviews medical records for quality of documentation, develops methodologies, and assists CDI specialists. Develops and presents related physician education programs. Assists CDI Specialists in developing and presenting related physician education programs. Qualifications Minimum Education and Experience Requirements:: Minimum 5 years recent experience as a CDI specialist. Graduate of an accredited school of nursing with current RN licensure in the State of Florida or Certified Clinical Documentation Specialist...

PURPOSE AND SCOPE: Supports the Organization mission, vision, core values and customer service philosophy.  Adheres to the Organization Compliance Program, including following all regulatory and Organization policy requirements. Provides direct nursing care pre, during and post procedure, under the direction of the Facility Manager, Director of Nursing and/or Charge Registered Nurse, utilizing standard nursing techniques to assist the physician in optimum patient outcomes following facility policies and procedures. PRINCIPAL DUTIES AND RESPONSIBILITIES: QUALITY: Responsible for supporting and driving organization quality standards through meeting regulatory and accrediting body requirements and the practice of Continuous Quality Improvement (CQI), including use of CQI tools. Assists with implementation of organization quality goals and facility specific action plans in order to achieve organization quality standards. Accountable for outstanding...

PURPOSE AND SCOPE: Supports FMCNA's mission, vision, core values and customer service philosophy.  Adheres to the FVC/FMCNA Compliance Program, including following all regulatory and FVC/FMS policy requirements. Provides direct nursing care pre, during and post procedure, under the direction of the Facility Manager and/or Charge Registered Nurse, utilizing standard nursing techniques to assist the physician in optimum patient outcomes following facility policies and procedures.   PRINCIPAL DUTIES AND RESPONSIBILITIES: QUALITY: Responsible for supporting and driving FVC quality standards through meeting regulatory and accrediting body requirements and the practice of Continuous Quality Improvement (CQI), including use of FVC/FMS CQI       tools. Assists with implementation of FVC quality goals and facility specific action plans in order to achieve FVC quality standards. Accountable for outstanding quality of patient care, as defined by the...

Inspire health. Serve with compassion. Be the difference. Job Summary Provides clinical direction for all aspects of patient care in an acute inpatient setting, fostering patient/family centered care. Demonstrates clinical competency utilizing evidence based practices/research in al areas of the nursing process: assessment, planning, implementation, evaluation and outcomes. Incorporates knowledge of safety protocols, cost containment and quaility improvement throughout the nursing process. Identifies patient, unit and organizational priorities and incorporates into the nursing process. Adheres to all compliance and policy/procedures of the organization including, but not limited to: licensure renewal, assigned training, employee health screenings, time and attendance poilicy, dress code policy, patient confiendtiality, infection control, medication administration. Demonstrates knowledge of regulatory agency requirements (TJC, DHEC, CMS). Provides care within the scope...

Inspire health. Serve with compassion. Be the difference. Job Summary Provides clinical direction for all aspects of patient care in an acute inpatient setting, fostering patient/family centered care. Demonstrates clinical competency utilizing evidence-based practices/research in all areas of the nursing process: assessment, planning, implementation, evaluation and outcomes. Incorporates knowledge of safety protocols, cost containment and quality improvement throughout the nursing process. Identifies patient, unit and organizational priorities and incorporates into the nursing process. Adheres to all compliance and policy/procedures of the organization including, but not limited to licensure renewal, assigned training, employee health screenings, time and attendance policy, dress code policy, patient confidentiality, infection control, medication administration. Demonstrates knowledge of regulatory agency requirements (TJC, DHEC, CMS). Provides care within the scope of...

Inspire health. Serve with compassion. Be the difference. Job Summary Provides clinical direction for all aspects of patient care in an acute inpatient setting, fostering patient/family centered care. Demonstrates clinical competency utilizing evidence-based practices/research in all areas of the nursing process: assessment, planning, implementation, evaluation and outcomes. Incorporates knowledge of safety protocols, cost containment and quality improvement throughout the nursing process. Identifies patient, unit and organizational priorities and incorporates into the nursing process. Adheres to all compliance and policy/procedures of the organization including, but not limited to licensure renewal, assigned training, employee health screenings, time and attendance policy, dress code policy, patient confidentiality, infection control, medication administration. Demonstrates knowledge of regulatory agency requirements (TJC, SC DPH, CMS). Provides care within the scope of...

Inspire health. Serve with compassion. Be the difference. Job Summary Provides clinical direction for all aspects of patient care in an acute inpatient setting, fostering patient/family centered care. Demonstrates clinical competency utilizing evidence-based practices/research in all areas of the nursing process: assessment, planning, implementation, evaluation and outcomes. Incorporates knowledge of safety protocols, cost containment and quality improvement throughout the nursing process. Identifies patient, unit and organizational priorities and incorporates into the nursing process. Adheres to all compliance and policy/procedures of the organization including, but not limited to licensure renewal, assigned training, employee health screenings, time and attendance policy, dress code policy, patient confidentiality, infection control, medication administration. Demonstrates knowledge of regulatory agency requirements (TJC, SC DPH, CMS). Provides care within the scope of...

Inspire health. Serve with compassion. Be the difference. Job Summary Provides clinical direction for all aspects of patient care in an acute inpatient setting, fostering patient/family centered care. Demonstrates clinical competency utilizing evidence-based practices/research in all areas of the nursing process: assessment, planning, implementation, evaluation and outcomes. Incorporates knowledge of safety protocols, cost containment and quality improvement throughout the nursing process. Identifies patient, unit and organizational priorities and incorporates into the nursing process. Adheres to all compliance and policy/procedures of the organization including, but not limited to licensure renewal, assigned training, employee health screenings, time and attendance policy, dress code policy, patient confidentiality, infection control, medication administration. Demonstrates knowledge of regulatory agency requirements (TJC, SC DPH, CMS). Provides care within the scope of...

Inspire health. Serve with compassion. Be the difference. Job Summary Provides clinical direction for all aspects of patient care in an acute inpatient setting, fostering patient/family centered care. Demonstrates clinical competency utilizing evidence-based practices/research in all areas of the nursing process: assessment, planning, implementation, evaluation and outcomes. Incorporates knowledge of safety protocols, cost containment and quality improvement throughout the nursing process. Identifies patient, unit and organizational priorities and incorporates into the nursing process. Adheres to all compliance and policy/procedures of the organization including, but not limited to licensure renewal, assigned training, employee health screenings, time and attendance policy, dress code policy, patient confidentiality, infection control, medication administration. Demonstrates knowledge of regulatory agency requirements (TJC, SC DPH, CMS). Provides care within the scope...

Inspire health. Serve with compassion. Be the difference. Job Summary Provides clinical direction for all aspects of patient care in an acute inpatient setting, fostering patient/family centered care. Demonstrates clinical competency utilizing evidence-based practices/research in all areas of the nursing process: assessment, planning, implementation, evaluation and outcomes. Incorporates knowledge of safety protocols, cost containment and quality improvement throughout the nursing process. Identifies patient, unit and organizational priorities and incorporates into the nursing process. Adheres to all compliance and policy/procedures of the organization including, but not limited to licensure renewal, assigned training, employee health screenings, time and attendance policy, dress code policy, patient confidentiality, infection control, medication administration. Demonstrates knowledge of regulatory agency requirements (TJC, DHEC, CMS). Provides care within the scope...

Inspire health. Serve with compassion. Be the difference. Job Summary Provides clinical direction for all aspects of patient care in an acute inpatient setting, fostering patient/family centered care. Demonstrates clinical competency utilizing evidence-based practices/research in all areas of the nursing process: assessment, planning, implementation, evaluation and outcomes. Incorporates knowledge of safety protocols, cost containment and quality improvement throughout the nursing process. Identifies patient, unit and organizational priorities and incorporates into the nursing process. Adheres to all compliance and policy/procedures of the organization including, but not limited to licensure renewal, assigned training, employee health screenings, time and attendance policy, dress code policy, patient confidentiality, infection control, medication administration. Demonstrates knowledge of regulatory agency requirements (TJC, SC DPH, CMS). Provides care within the scope...

Inspire health. Serve with compassion. Be the difference. Job Summary Provides clinical direction for all aspects of patient care in an acute inpatient setting, fostering patient/family centered care. Demonstrates clinical competency utilizing evidence-based practices/research in all areas of the nursing process: assessment, planning, implementation, evaluation and outcomes. Incorporates knowledge of safety protocols, cost containment and quality improvement throughout the nursing process. Identifies patient, unit and organizational priorities and incorporates into the nursing process. Adheres to all compliance and policy/procedures of the organization including, but not limited to licensure renewal, assigned training, employee health screenings, time and attendance policy, dress code policy, patient confidentiality, infection control, medication administration. Demonstrates knowledge of regulatory agency requirements (TJC, SC DPH, CMS). Provides care within the scope...

Inspire health. Serve with compassion. Be the difference. Job Summary Provides clinical direction for all aspects of patient care in an acute inpatient setting, fostering patient/family centered care. Demonstrates clinical competency utilizing evidence-based practices/research in all areas of the nursing process: assessment, planning, implementation, evaluation and outcomes. Incorporates knowledge of safety protocols, cost containment and quality improvement throughout the nursing process. Identifies patient, unit and organizational priorities and incorporates into the nursing process. Adheres to all compliance and policy/procedures of the organization including, but not limited to licensure renewal, assigned training, employee health screenings, time and attendance policy, dress code policy, patient confidentiality, infection control, medication administration. Demonstrates knowledge of regulatory agency requirements (TJC, SC DPH, CMS). Provides care within the scope...

Inspire health. Serve with compassion. Be the difference. Job Summary Provides clinical direction for all aspects of patient care in an acute inpatient setting, fostering patient/family centered care. Demonstrates clinical competency utilizing evidence based practices/research in al areas of the nursing process: assessment, planning, implementation, evaluation and outcomes. Incorporates knowledge of safety protocols, cost containment and quaility improvement throughout the nursing process. Identifies patient, unit and organizational priorities and incorporates into the nursing process. Adheres to all compliance and policy/procedures of the organization including, but not limited to: licensure renewal, assigned training, employee health screenings, time and attendance poilicy, dress code policy, patient confiendtiality, infection control, medication administration. Demonstrates knowledge of regulatory agency requirements (TJC, DHEC, CMS). Provides care within the...

Inspire health. Serve with compassion. Be the difference. Job Summary Provides clinical direction for all aspects of patient care in an acute inpatient setting, fostering patient/family centered care. Demonstrates clinical competency utilizing evidence based practices/research in al areas of the nursing process: assessment, planning, implementation, evaluation and outcomes. Incorporates knowledge of safety protocols, cost containment and quaility improvement throughout the nursing process. Identifies patient, unit and organizational priorities and incorporates into the nursing process. Adheres to all compliance and policy/procedures of the organization including, but not limited to: licensure renewal, assigned training, employee health screenings, time and attendance poilicy, dress code policy, patient confiendtiality, infection control, medication administration. Demonstrates knowledge of regulatory agency requirements (TJC, DHEC, CMS). Provides care within the scope...

Inspire health. Serve with compassion. Be the difference. Job Summary Provides clinical direction for all aspects of patient care in an acute inpatient setting, fostering patient/family centered care. Demonstrates clinical competency utilizing evidence-based practices/research in all areas of the nursing process: assessment, planning, implementation, evaluation and outcomes. Incorporates knowledge of safety protocols, cost containment and quality improvement throughout the nursing process. Identifies patient, unit and organizational priorities and incorporates into the nursing process. Adheres to all compliance and policy/procedures of the organization including, but not limited to licensure renewal, assigned training, employee health screenings, time and attendance policy, dress code policy, patient confidentiality, infection control, medication administration. Demonstrates knowledge of regulatory agency requirements (TJC, SC DPH, CMS). Provides care within the scope...

Inspire health. Serve with compassion. Be the difference. Job Summary Provides clinical direction for all aspects of patient care in an acute inpatient setting, fostering patient/family centered care. Demonstrates clinical competency utilizing evidence-based practices/research in all areas of the nursing process: assessment, planning, implementation, evaluation and outcomes. Incorporates knowledge of safety protocols, cost containment and quality improvement throughout the nursing process. Identifies patient, unit and organizational priorities and incorporates into the nursing process. Adheres to all compliance and policy/procedures of the organization including, but not limited to licensure renewal, assigned training, employee health screenings, time and attendance policy, dress code policy, patient confidentiality, infection control, medication administration. Demonstrates knowledge of regulatory agency requirements (TJC, SC DPH, CMS). Provides care within the scope...

Inspire health. Serve with compassion. Be the difference. Job Summary Provides clinical direction for all aspects of patient care in an acute inpatient setting, fostering patient/family centered care. Demonstrates clinical competency utilizing evidence-based practices/research in all areas of the nursing process: assessment, planning, implementation, evaluation and outcomes. Incorporates knowledge of safety protocols, cost containment and quality improvement throughout the nursing process. Identifies patient, unit and organizational priorities and incorporates into the nursing process. Adheres to all compliance and policy/procedures of the organization including, but not limited to licensure renewal, assigned training, employee health screenings, time and attendance policy, dress code policy, patient confidentiality, infection control, medication administration. Demonstrates knowledge of regulatory agency requirements (TJC, DHEC, CMS). Provides care within the scope...

Inspire health. Serve with compassion. Be the difference. Job Summary Provides clinical direction for all aspects of patient care in an acute inpatient setting, fostering patient/family centered care. Demonstrates clinical competency utilizing evidence-based practices/research in all areas of the nursing process: assessment, planning, implementation, evaluation and outcomes. Incorporates knowledge of safety protocols, cost containment and quality improvement throughout the nursing process. Identifies patient, unit and organizational priorities and incorporates into the nursing process. Adheres to all compliance and policy/procedures of the organization including, but not limited to licensure renewal, assigned training, employee health screenings, time and attendance policy, dress code policy, patient confidentiality, infection control, medication administration. Demonstrates knowledge of regulatory agency requirements (TJC, SC DPH, CMS). Provides care within the scope...