Quality Management Nurse Consultant
3 weeks ago
Responsible for the review and evaluation of clinical information and documentation.
Reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues.
Independently coordinates the clinical resolution with internal/external clinician support as required.
Requires an RN with unrestricted active license
Reviews documentation and evaluates potential quality of care issues based on clinical policies and benefit determinations.
Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation. Data gathering requires navigation through multiple system applications.
Staff may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information.-Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines.
Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the issueat hand.
Commands a comprehensive knowledge of complex delegation arrangements, contracts ,clinical criteria, benefit plan structure, regulatory requirements, company policy and other processes which are required to support the review of the clinical documentation/information.
Pro-actively and consistently applies the regulatory and accreditation standards to assure that activities are reviewed and processed within guidelines.-Condenses complex information into a clear and precise clinical picture while working independently.
Reports audit or clinical findings to appropriate staff or others in order to ensure appropriate outcome and/or follow-up for improvement as indicated.
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Quality Manager
2 weeks ago
Providence, United States DSJ Global Full timeDSJ Global is partnered with a leading manufacturer in the Chemical industry. This company contributes to making chemicals to are used in semiconductor manufacturing. They are looking to add a Quality Manager to their team in the Rhode Island area. This role will primarily be responsible for leading and executing the quality manufacturing process of the...
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Nurse Medical Management
2 months ago
Providence, United States Absolute Staffing & Consulting Solutions Full timeJob DescriptionJob DescriptionAbsolute Staffing is searching for Nurse Medical Management to work with our Client. Job Location: RI, MA or CTThe Nurse Medical Mgmt Il is responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources for more complex...
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Employee Relations Manager
2 weeks ago
Providence, United States Clinical Management Consultants Full timeMUST LIVE IN MASSACHUSETTS or RHODE ISLAND Unlock the door to a rewarding remote career opportunity! Join one of the world's best healthcare systems, nestled in the vibrant community of Massachusetts. This organization is on a quest for an innovative and experienced Employee Relations Manager to shape the future of workplace culture and relations. This...
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BMT Quality Manager
1 week ago
Providence, United States CharterCARE Health Partners Full timeSummary:Is designated as the quality manager for the Bone Marrow Transplant Program. Prepares for and participates in audits and inspections conducted by various cooperative groups and regulatory bodies. Coordinates/oversees the multi-disciplinary quality management meetings. Coordinates and manages data collection, and prepares reports using established...
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BMT Quality Manager
10 hours ago
Providence, United States CharterCARE Health Partners Full timeSummary: Is designated as the quality manager for the Bone Marrow Transplant Program. Prepares for and participates in audits and inspections conducted by various cooperative groups and regulatory bodies . Coordinates/oversees the multi-disciplinary quality management meetings. Coordinates and manages data collection, and prepares reports using established...
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Providence, United States Lifespan Corporation Full timeSummary: The Perioperative Nursing Director of Quality and Safety reports to the Lifespan Vice President and RIH/HCH Associate Chief Nursing Officer of Perioperative Services with a matrix to Lifespans Chief Quality Officer. This role collaborates with the Directors of Quality across the system. Under general supervision and within Lifespan established...
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Director Perioperative Nursing Quality and Safety
17 hours ago
Providence, United States Lifespan Corporation Full timeSummary: The Perioperative Nursing Director of Quality and Safety reports to the Lifespan Vice President and RIH/HCH Associate Chief Nursing Officer of Perioperative Services with a matrix to Lifespans Chief Quality Officer. This role collaborates with the Directors of Quality across the system. Under general supervision and within Lifespan established...
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Providence, United States Oracle Full timeOracle Senior Project Manager | Energy and Water Consulting Providence , Rhode Island Apply Now Oracle Energy and Water provides the most comprehensive platform of innovative solutions to empower utility business transformation—from asset operations to the customer experience. These innovative solutions enable today's electric, gas, and water utilities to...
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Senior Project Manager | Energy and Water Consulting
14 hours ago
Providence, United States Oracle Full timeOracle Senior Project Manager | Energy and Water Consulting Providence , Rhode Island Apply Now Oracle Energy and Water provides the most comprehensive platform of innovative solutions to empower utility business transformation—from asset operations to the customer experience. These innovative solutions enable today's electric, gas, and water utilities to...
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Technical Solution Consultant
1 week ago
Providence, United States Cornerstone OnDemand Full timeCornerstone onDemand Technical Solution Consultant Providence , Rhode Island Apply Now We are seeking a Technical Solution Consultant that will be part of the sales team and is responsible for working closely with Sales Representatives, RVPs, Account Managers and Solution Consultants. The goal is to gain new customers and educate existing customers on our...
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Plasma Services Consultant
1 week ago
Providence, United States Fresenius Kabi USA, LLC Full timeJob Summary The Plasma Services Consultant is responsible for providing technical and operator l product and sales support for customer organizations within an assigned territory in US. Act as key customer liaison and consultant managing both customer and company needs. Assist in process and operational improvements within a customer center and ensures that...
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Plasma Services Consultant
23 hours ago
Providence, United States Fresenius Kabi USA, LLC Full timeJob Summary The Plasma Services Consultant is responsible for providing technical and operator l product and sales support for customer organizations within an assigned territory in US. Act as key customer liaison and consultant managing both customer and company needs. Assist in process and operational improvements within a customer center and ensures that...
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Senior Project Manager
1 week ago
Providence, United States O'Connor Construction Management Inc. Full timeProject and Construction ManagementNew Haven,ConnecticutProvidence,Rhode IslandBoston,MassachusettsHartford,ConnecticutYonkers,New York OCMI, Inc.(OCMI) is a full service, independent construction management company with over 41 years’ experience in the industry. We have offices in Dallas, Las Vegas, Seattle, Charlotte, Washington D.C., and throughout...
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Providence, United States Fidelity Investments Full timeWealth Management Consultant Fidelity Investments Providence, United States Wealth Management Consultant Fidelity Investments Providence, United States Posted 3 days ago Permanent Competitive Wealth Management Consultant “Fidelity believes in, and is committed to, fair and consistent treatment for every associate and customer, and to creating a safe and...
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Collibra Data Quality Engineer
2 weeks ago
Providence, United States Tekgence Inc Full timeCandidate must have the minimum of 10+ years of experience working as an Sr/lead developer.Must have relevant experience of min 5 years in Collibra Data quality with DBT and Data Vault experience with Data Governance and Catalog tool.Hands-on with Advanced SQL and Snowflake experienceExperience of working in healthcare domain (Claims, Clininal & Encounter)...
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Collibra Data Quality Engineer
2 weeks ago
Providence, United States Tekgence Inc Full timeCandidate must have the minimum of 10+ years of experience working as an Sr/lead developer.Must have relevant experience of min 5 years in Collibra Data quality with DBT and Data Vault experience with Data Governance and Catalog tool.Hands-on with Advanced SQL and Snowflake experienceExperience of working in healthcare domain (Claims, Clininal & Encounter)...
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Collibra Data Quality Engineer
2 weeks ago
Providence, United States Tekgence Inc Full timeCandidate must have the minimum of 10+ years of experience working as an Sr/lead developer.Must have relevant experience of min 5 years in Collibra Data quality with DBT and Data Vault experience with Data Governance and Catalog tool.Hands-on with Advanced SQL and Snowflake experienceExperience of working in healthcare domain (Claims, Clininal & Encounter)...
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Collibra Data Quality Engineer
6 days ago
Providence, United States Tekgence Full timeCandidate must have the minimum of 10+ years of experience working as an Sr/lead developer. Must have relevant experience of min 5 years in Collibra Data quality with DBT and Data Vault experience with Data Governance and Catalog tool. Hands-on with Advanced SQL and Snowflake experience Experience of working in healthcare domain (Claims, Clininal &...
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Quality Project Manager
2 weeks ago
Providence, United States Vertex Pharmaceuticals Full timeJob Description: This Quality Project Manager will be responsible for supporting cross-functional project teams executing Quality strategies within multiple programs. This individual will work with the Quality leads and interface directly with internal cross-functional teams. This individual will track, report, and project scope/timeline/milestone status...
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Quality Assurance and Accreditation Lead
3 weeks ago
Providence, United States Babson College Full timeThe Quality Assurance and Accreditation Lead will provide leadership and direction for a client needs assessment for Babson Global and its client organization in KSA. This position is involved in the assessment, design, and implementation of quality assurance and accreditation management systems that meet international collegiate business school standards,...