Nurse Utilization Review Specialist

2 weeks ago


Corona, New York, United States VNS Health Full time
Job Title: Registered Nurse - Utilization Review

VNS Health is seeking a skilled Registered Nurse to join our team as a Utilization Review Specialist. In this role, you will play a critical part in ensuring the highest quality of care for our patients.

Job Summary:

The Utilization Review Specialist will be responsible for conducting clinical assessments, collaborating with healthcare providers, and leading quality improvement initiatives to optimize patient outcomes and satisfaction.

Key Responsibilities:
  • Conduct clinical assessments, including medication reconciliations, post-discharge transitions of care, and emergency department assessments.
  • Collaborate with healthcare providers to ensure compliance with regulatory requirements and industry benchmarks.
  • Lead quality improvement initiatives to address non-adherence and clinical diagnosis for HEDIS/QARR exclusion.
  • Participate in improvement teams and projects to enhance performance, measurement, and documentation.
  • Perform audits on medical records and provide guidance to healthcare providers on documentation standards.
  • Develop and implement corrective action plans based on quality reviews and root cause analysis findings.
Requirements:
  • License and current registration to practice as a Registered Professional Nurse in New York State.
  • Minimum of three years quality improvement experience in a health plan or healthcare setting.
  • Excellent oral, written, and interpersonal communication skills, including group facilitation skills.
About VNS Health:

VNS Health is a nonprofit home and community-based healthcare organization dedicated to delivering compassionate care and unparalleled expertise to our patients. We offer a range of health care services, solutions, and health plans designed to simplify the healthcare experience and meet the diverse and complex needs of those we serve.

Benefits:
  • Guaranteed hours
  • 401k retirement plan
  • Employee assistance programs
  • Dental benefits
  • Vision benefits
  • License and certification reimbursement
  • Life insurance
  • Discount program
  • Holiday pay
  • Continuing education
  • Wellness and fitness programs
  • Mileage reimbursement
  • Medical benefits


  • Corona, New York, United States VNS Health Full time

    Job Title: Registered Nurse - Utilization ReviewVNS Health is seeking a skilled Registered Nurse to join our team as a Utilization Review Specialist. In this role, you will play a critical part in ensuring the highest quality of care for our patients.Job Summary:The Registered Nurse - Utilization Review will be responsible for conducting clinical...


  • Corona, New York, United States VNS Health Full time

    Job Title: Medical Care SpecialistVNS Health is seeking a skilled Medical Care Specialist to join our team in West New York, New Jersey.About the Role:This is a nursing job that requires a Registered Nurse (RN) with experience in clinic utilization review. The successful candidate will be responsible for resolving grievances, appeals, and external reviews...


  • Corona, New York, United States VNS Health Full time

    Job Title: Medical Care NurseVNS Health is seeking a skilled Registered Nurse to join our team as a Clinic Utilization Review professional in West New York, New Jersey.Job Summary:We are looking for a highly motivated and detail-oriented Registered Nurse to resolve grievances, appeals, and external reviews for our VNS Health Plans product lines. The ideal...

  • Registered Nurse

    6 days ago


    Corona, New York, United States VNS Health Full time

    Job Title: Registered Nurse - Home Health SpecialistVNS Health is seeking a skilled Registered Nurse to join our team as a Home Health Specialist. As a key member of our interdisciplinary care team, you will be responsible for providing high-quality patient care and support to individuals in their homes.Responsibilities:Conduct comprehensive health...

  • Travel Nurse RN

    3 weeks ago


    Corona, New York, United States TravelNurseSource Full time

    About the PositionWe are seeking a highly skilled and experienced Med/Surg Registered Nurse to join our team of travel nurses. As a travel nurse with TravelNurseSource, you will have the opportunity to work in a variety of healthcare settings and locations, while enjoying competitive pay and benefits.ResponsibilitiesProvide high-quality patient care in a...

  • Registered Nurse

    6 days ago


    Corona, New York, United States VNS Health Full time

    Job Title: Registered Nurse - Home Health Care SpecialistVNS Health is seeking a skilled Registered Nurse to join our Home Health team as a Home Health Care Specialist. As a key member of our interdisciplinary care team, you will be responsible for providing high-quality patient care and support to individuals in their homes.Responsibilities:Conduct...


  • Corona, New Mexico, United States Quanta Services Full time

    About UsFiberTel, LLC is a leading provider of utility construction services, specializing in the installation of fiber optics. As a subsidiary of Quanta Services, Inc., we offer a full turnkey experience for our clients, with a focus on delivering high-quality results and exceptional customer service.Job SummaryWe are seeking an experienced Construction...


  • Corona, New York, United States HANAC Inc Full time

    About HANAC, Inc.HANAC, Inc. is a prominent social services organization based in New York City, dedicated to addressing the needs of vulnerable communities since its inception in 1972. Our mission is to empower individuals and families through comprehensive support and resources.Position Overview:The Family Support Specialist plays a crucial role in...


  • Corona, New York, United States VNS Health Full time

    Job Title: Wound Care SpecialistVNS Health is seeking a highly skilled Wound Care Specialist to join our team. As a Registered Nurse with expertise in wound care, you will play a critical role in providing high-quality patient care and promoting optimal outcomes.Key Responsibilities:Develop and implement evidence-based wound care plans to promote healing and...


  • Corona, New York, United States VNS Health Full time

    Job Title: Wound Care SpecialistVNS Health is seeking a highly skilled Wound Care Specialist to join our team. As a Registered Nurse with expertise in wound care, you will play a critical role in providing high-quality patient care and promoting optimal outcomes.Key Responsibilities:Develop and implement evidence-based wound care plans to promote healing and...


  • Corona, New York, United States VNS Health Full time

    Job Title: Wound Care SpecialistVNS Health is seeking a highly skilled Wound Care Specialist to join our team. As a Registered Nurse with expertise in wound care, you will play a critical role in providing high-quality patient care and promoting optimal outcomes.Key Responsibilities:Develop and implement evidence-based wound care plans to promote healing and...

  • Nurse Educator

    2 weeks ago


    Corona, New York, United States HealthEcareers - Client Full time

    About the RoleWe are seeking a highly skilled Nurse Educator to join our team at HealthEcareers - Client. As a Nurse Educator, you will play a critical role in shaping the future of healthcare through education and training.Key ResponsibilitiesDevelop and deliver high-quality clinical education programs to foster high-quality care through evidence-based...


  • Corona, New York, United States PRACTICE Benefit Corp Full time

    Job OverviewPosition: School Technology Support SpecialistCompany: PRACTICE Benefit CorpRole Summary: We are looking for a dedicated and proactive individual to provide essential technical support within an educational environment. As a School Technology Support Specialist, you will be instrumental in addressing and resolving technology-related challenges...

  • Licensed Psychologist

    3 weeks ago


    Corona, New York, United States MRG Exams Careers Full time

    About MRG Exams CareersMRG Exams Careers is a leading provider of independent medical exams for workers' compensation, disability, and the Veterans Administration. Our mission is to serve our veterans and help military families achieve work-life balance.Job OverviewWe are seeking a licensed psychologist to perform medical assessments on United States...

  • Nurse Specialist

    3 weeks ago


    Corona, New York, United States VNS Health Full time

    About the RoleVNS Health is seeking a skilled Nurse Specialist to provide personalized nursing and care management to patients in their homes or care facilities.Key ResponsibilitiesPractice independently in the community, delivering high-quality care to patients with diverse needs.Develop and implement individualized care plans, constantly evaluating and...


  • Corona, New York, United States VNS Health Full time

    Job Title: Wound Care SpecialistVNS Health is seeking a highly skilled Wound Care Specialist to join our team. As a Registered Nurse with a passion for wound management, you will play a critical role in delivering high-quality care to our patients.Key Responsibilities:Manage the monitoring systems used for the evaluation and tracking of the wound management...


  • Corona, New York, United States Somos Organic Cleaning Full time

    Job OverviewJoin Our Eco-Conscious Cleaning Team!Position: Residential Cleaning SpecialistAre you enthusiastic about maintaining cleanliness while contributing positively to the environment? Somos Organic Cleaning is seeking reliable and dedicated individuals to become part of our exceptional cleaning team.What We Offer:Attractive Compensation: We appreciate...

  • Wound Care Specialist

    2 weeks ago


    Corona, New York, United States VNS Health Full time

    Job Title: Registered Nurse - Wound CareVNS Health is seeking a skilled Registered Nurse to join our team as a Wound Care Specialist. As a key member of our healthcare team, you will play a vital role in providing high-quality care to our patients.About the Role:Develop and implement population/disease management programs and related protocols/policies based...

  • Clinical Psychologist

    3 weeks ago


    Corona, New York, United States MRG Exams Careers Full time

    About the RoleWe are seeking a highly skilled and experienced Licensed Psychologist to join our team at MRG Exams Careers as a Disability Assessment Specialist. In this role, you will be responsible for conducting comprehensive assessments on United States Veterans as part of the VA's disability benefits process.Key ResponsibilitiesReview behavioral health...


  • Corona, New York, United States VNS Health Full time

    Job Title: Registered Nurse - Wound CareVNS Health is seeking a skilled Registered Nurse to join our team as a Wound Care Specialist. As a key member of our healthcare team, you will be responsible for managing the wound management program and initiatives for all VNS Health provider services.Key Responsibilities:Manage the monitoring systems used for the...