**Nurse Utilization Review Specialist**

6 days ago

Edgewater, New Jersey, United States VNS Health Full time

About the Role:

VNS Health is seeking a skilled Nurse Utilization Review Specialist to join our team. As a key member of our quality improvement team, you will play a critical role in ensuring the highest level of patient care and satisfaction.

Key Responsibilities:

  • Conduct clinical assessments, including medication reconciliations, post-discharge transitions of care, and follow-up assessments.
  • Collaborate with programs to ensure compliance with regulatory requirements, including DOH, CMS, and NCQA.
  • Coach, facilitate, and monitor continuous improvement to attain strategic quality objectives and industry benchmarks for patient outcomes, satisfaction, cost, and regulatory requirements.
  • Conduct clinical reviews with primary care providers or specialists to address non-adherence and/or clinical diagnosis for HEDIS/QARR exclusion.
  • Participate and lead improvement teams and projects related to performance improvement, measurement, and documentation.
  • Perform audits on medical records and provide counseling/guidance to PCPs on VNS Health Medical Record Documentation Standards.
  • Develop forms, record abstracts, reports, and other tools used to implement concurrent and retrospective patient care review.
  • Perform utilization and quality assessment reviews to maintain compliance with Federal and State regulatory requirements.
  • Identify and analyze results to inform the development of correction plans.
  • Develop action plans in collaboration with management staff based on quality reviews and root cause analysis findings.
  • Make recommendations to appropriate staff and/or committees about findings of reviews, surveys, and studies.
  • Participate in the preparation for and assist with site visits of outside providers for the purpose of regulatory quality compliance.
  • Investigate patient-related complaints, at the direction of the Director.
  • Prepare related reports of investigations and recommendations for correction/improvement.
  • Develop training materials for and spread protocols/standards for patient populations within a collaborative framework.
  • Conduct follow-ups and reassessment and report findings to evaluate whether corrective actions for regulatory issues, compliance, or deficiencies identified in patient complaints/incidents were implemented effectively.
  • Develop processes, policies, and procedures related to current practice and changes in regulatory and industry requirements.
  • Collect and feed back data on performance improvement for teams within a region/program.

Requirements:

  • License and current registration to practice as a Registered Professional Nurse in New York State required.
  • Minimum of three years quality improvement experience in a health plan or healthcare setting required.
  • Minimum of one year experience in quality management, practice improvement, and compliance preferred.
  • Demonstrated leadership experience preferred.
  • Excellent oral, written, and interpersonal communication skills, including group facilitation skills required.

  • Nurse Utilization Review Specialist

    5 days ago

    Edgewater, New Jersey, United States VNS Health Full time

    About the RoleVNS Health is seeking a skilled Nurse Utilization Review Specialist to join our team. As a key member of our quality improvement team, you will play a critical role in ensuring the highest level of patient care and satisfaction.Key ResponsibilitiesConduct thorough clinical assessments, including medication reconciliations, post-discharge...

  • Nurse Utilization Review Specialist

    7 days ago

    Edgewater, New Jersey, United States VNS Health Full time

    About the RoleVNS Health is seeking a skilled Nurse Utilization Review Specialist to join our team. As a key member of our quality improvement team, you will play a critical role in ensuring the highest level of patient care and satisfaction.Key ResponsibilitiesConduct thorough clinical assessments, including medication reconciliations, post-discharge...

  • **Nurse Utilization Review Specialist**

    1 week ago

    Edgewater, New Jersey, United States VNS Health Full time

    **Job Summary**VNS Health is seeking a skilled Registered Nurse to lead interdepartmental quality improvement activities, including development and engagement, clinical review, clinical risk management, and patient satisfaction.**Key Responsibilities****Lead Quality Improvement Initiatives**: Develop and implement quality improvement programs to promote...

  • Nurse Specialist

    16 hours ago

    Edgewater, New Jersey, United States Montefiore Medical Center Full time

    Job Title: Nurse SpecialistWe are seeking a skilled Nurse Specialist to join our team at Montefiore Medical Center. As a Nurse Specialist, you will play a vital role in providing high-quality patient care and contributing to the success of our healthcare team.Job Summary:The Nurse Specialist will be responsible for:Providing direct patient care in the...

  • Nurse Specialist

    5 days ago

    Edgewater, New Jersey, United States Montefiore Medical Center Full time

    Job OpportunityMontefiore Medical Center is seeking a skilled Nurse Specialist for a nursing position in a dynamic environment.Job SummaryThe Nurse Specialist will be responsible for providing high-quality patient care and maintaining standards of practice for nursing as defined by the American Nurses Association Code of Ethics, Nursing Scope and Standards...

  • Nurse Specialist

    4 days ago

    Edgewater, New Jersey, United States Montefiore Medical Center Full time

    Job OpportunityMontefiore Medical Center is seeking a skilled Nurse Specialist for a nursing position in a dynamic environment.Job SummaryThe Nurse Specialist will be responsible for providing high-quality patient care and maintaining standards of practice for nursing as defined by the American Nurses Association Code of Ethics, Nursing Scope and Standards...

  • Nurse Specialist

    5 days ago

    Edgewater, New Jersey, United States Montefiore Medical Center Full time

    Job OpportunityMontefiore Medical Center is seeking a skilled Nurse Specialist for a nursing position in a dynamic environment.Job SummaryThe Nurse Specialist will be responsible for providing high-quality patient care and maintaining standards of practice for nursing as defined by the American Nurses Association Code of Ethics, Nursing Scope and Standards...

  • Nurse Specialist

    6 days ago

    Edgewater, New Jersey, United States Montefiore Medical Center Full time

    Job OpportunityMontefiore Medical Center is seeking a skilled Nurse Specialist for a nursing position in the Emergency Department.Job SummaryWe are looking for a dedicated and compassionate Nurse Specialist to provide high-quality patient care in our Emergency Department. The ideal candidate will have a strong background in nursing and excellent...

  • Nurse Specialist

    4 days ago

    Edgewater, New Jersey, United States Montefiore Medical Center Full time

    Job OpportunityMontefiore Medical Center is seeking a skilled Nurse Specialist for a nursing position in a dynamic environment.Job SummaryThe Nurse Specialist will be responsible for providing high-quality patient care and maintaining standards of practice for nursing as defined by the American Nurses Association Code of Ethics, Nursing Scope and Standards...

  • Nurse Specialist

    5 days ago

    Edgewater, New Jersey, United States Montefiore Medical Center Full time

    Job DescriptionMontefiore Medical Center is seeking a skilled Nurse Specialist for a nursing position in a dynamic healthcare environment.Key ResponsibilitiesProvide high-quality patient care and maintain a safe and healthy environment.Collaborate with healthcare teams to develop and implement effective care plans.Monitor patient progress and adjust care...

  • Nurse Specialist

    4 days ago

    Edgewater, New Jersey, United States Montefiore Medical Center Full time

    Job Opportunity at Montefiore Medical CenterWe are seeking a highly skilled and dedicated Nurse Specialist to join our team at Montefiore Medical Center.Job SummaryThe Nurse Specialist will be responsible for providing high-quality patient care in our Medical Intensive Care Unit (MICU). This is a challenging and rewarding role that requires strong clinical...

  • Nurse Specialist

    5 days ago

    Edgewater, New Jersey, United States Montefiore Medical Center Full time

    Job SummaryMontefiore Medical Center is seeking a skilled Nurse Specialist to join our Women's Health team in Edgewater, New Jersey.Key ResponsibilitiesCoordinate and deliver high-quality patient care in the OB/GYN department, ensuring adherence to established standards and protocols.Collaborate with healthcare teams to develop and implement effective care...

  • Nurse Specialist

    6 days ago

    Edgewater, New Jersey, United States Montefiore Medical Center Full time

    Job Opportunity at Montefiore Medical CenterWe are seeking a highly skilled and dedicated Nurse Specialist to join our team at Montefiore Medical Center. As a leading academic medical center, we are committed to providing exceptional patient care and advancing the field of medicine.Job SummaryThe Nurse Specialist will be responsible for providing...

  • Nurse Specialist

    4 days ago

    Edgewater, New Jersey, United States Montefiore Medical Center Full time

    Job OpportunityMontefiore Medical Center is seeking a skilled Nurse Specialist to join our Intensive Care Unit team.Job SummaryThe Staff Nurse provides professional nursing care to assigned patients, assessing their needs and developing individualized care plans. This role requires strong clinical skills, effective communication, and a commitment to...

  • Nurse Specialist

    7 hours ago

    Edgewater, New Jersey, United States Montefiore Medical Center Full time

    Job OpportunityWe are seeking a skilled Nurse Specialist to join our team at Montefiore Medical Center.Job SummaryThe successful candidate will be responsible for providing high-quality patient care in a fast-paced telemetry environment.Key ResponsibilitiesDeliver exceptional patient care, adhering to the highest standards of nursing practice.Collaborate...

  • Nurse Specialist

    5 days ago

    Edgewater, New Jersey, United States HealthEcareers - Client Full time

    Job SummaryWe are seeking a skilled Nurse Specialist to join our team at HealthEcareers - Client. As a key member of our healthcare team, you will be responsible for providing high-quality patient care in our Neonatal Intensive Care Unit (NICU).Key ResponsibilitiesProvide direct patient care to critically ill newborns and their familiesDevelop and implement...

  • Nurse Specialist

    6 days ago

    Edgewater, New Jersey, United States Montefiore Medical Center Full time

    Job DescriptionMontefiore Medical Center is seeking a skilled Nurse Specialist for a nursing position in a dynamic healthcare environment.Key ResponsibilitiesProvide high-quality patient care and develop individualized care plans.Assess patients, administer medications, and supervise nursing staff.Collaborate with interdisciplinary teams to ensure seamless...

  • Nurse Specialist

    6 days ago

    Edgewater, New Jersey, United States Montefiore Medical Center Full time

    Job DescriptionMontefiore Medical Center is seeking a skilled Nurse Specialist for a nursing position in a dynamic healthcare environment.Key ResponsibilitiesProvide high-quality patient care as a Registered Nurse in a Float Pool setting.Collaborate with interdisciplinary teams to develop and implement individualized care plans.Participate in performance...

  • Nurse Specialist

    6 days ago

    Edgewater, New Jersey, United States Montefiore Medical Center Full time

    Job SummaryMontefiore Medical Center is seeking a skilled Nurse Specialist to join our team in Edgewater, New Jersey.Job ResponsibilitiesProvide high-quality patient care and develop individualized care plans.Assess patients, administer medications, and supervise nursing attendants and ancillary staff.Collaborate with healthcare teams to ensure seamless...

  • Nurse Specialist

    5 days ago

    Edgewater, New Jersey, United States Montefiore Medical Center Full time

    Job SummaryMontefiore Medical Center is seeking a skilled Nurse Specialist to join our team in a nursing role. As a Healthcare Professional, you will be responsible for providing high-quality patient care and contributing to the overall success of our medical center.Key ResponsibilitiesProvide direct patient care and develop individualized care plans to meet...