PACE Resource Management Registered Nurse San Ysidro Health CenterPACE Resource Management Registered NurseSan Diego, CAAccountability for relevant Key Performance Indicator's (KPI's) for Resource Management, including but not limited to obtaining information from Transitions of Care RN Case Managers, to synthesize the following: utilization rates per 100 participants per month for Urgent Care (UC), Emergency Department (ED) visits, Acute Hospital Admissions and Acute/post-acute Skilled Nursing Facility (SNF) Admissions and length of stay in hospital and SNF's. Performs prospective, initial, concurrent and retrospective reviews for medication utilization rates and costs, diagnostics/testing, referrals to specialists, durable medical equipment (DMEs), care giving hours and transportation utilization, assessing for appropriateness and medical necessity of the treatment requests using nationally recognized guidelines (InterQual or other criteria adopted by San Diego PACE).
NewPace Resource Management Registered Nurse San Ysidro Health CenterPace Resource Management Registered NurseSan Diego, CAExperience Preferred: 3 years or more of managed care experience including a year in resource utilization management, case management or care coordinationAt least 1 year working with the frail or elderlyStrong analytical skills with ability to quickly evaluate clinical documentation and apply evidence-based criteriaProject management skillsExperience performing audits analyzing productivity and quality of utilizationmanagementKnowledge and/or experience with the senior care market, including competitors, regulations, and available resourcesExperience with EPIC, Interqual and QuickCap. Accountability for relevant Key Performance Indicator's (KPI's) for Resource Management, including but not limited to obtaining information from Transitions of Care RN Case Managers, to synthesize the following: utilization rates per 100 participants per month for Urgent Care (UC), Emergency Department (ED) visits, Acute Hospital Admissions and Acute/post-acute Skilled Nursing Facility (SNF) Admissions and length of stay in hospital and SNF's.
Health Information Management II Family Health Centers of San Diego, Inc.Health Information Management IISan Diego, CA$25.50–$31.55 / hourServices include, but are not limited to adult care, chronic disease management, pediatrics, comprehensive women's care including obstetrics, dental, vision, case management, physical rehabilitation, speech therapy for children, vaccinations, infectious diseases, behavioral health, substance use counseling and a host of specialty services including cardiology, podiatry, endocrinology, dermatology, among others. We operate more than 90 sites across San Diego County, including 29 primary care clinics, 23 behavioral health facilities, 10 physical rehabilitation clinics, nine dental clinics, five vision clinics, four outpatient substance use treatment programs, three mobile medical units, two mobile counseling centers, two urgent care centers, and a pharmacy.
Health Information Management Specialist II - (In-Person, Chula Vista, CA) Family Health Centers of San Diego, Inc.Health Information Management Specialist II - (In-Person, Chula Vista, CA)San Diego, CA$25.50–$31.55 / hourServices include, but are not limited to adult care, chronic disease management, pediatrics, comprehensive women's care including obstetrics, dental, vision, case management, physical rehabilitation, speech therapy for children, vaccinations, infectious diseases, behavioral health, substance use counseling and a host of specialty services including cardiology, podiatry, endocrinology, dermatology, among others. We operate more than 90 sites across San Diego County, including 29 primary care clinics, 23 behavioral health facilities, 10 physical rehabilitation clinics, nine dental clinics, five vision clinics, four outpatient substance use treatment programs, three mobile medical units, two mobile counseling centers, two urgent care centers, and a pharmacy.
Health Information Management I Family Health Centers of San Diego IncHealth Information Management ISan Diego, CA$23.50–$29.08 / hourServices include, but are not limited to adult care, chronic disease management, pediatrics, comprehensive women's care including obstetrics, dental, vision, case management, physical rehabilitation, speech therapy for children, vaccinations, infectious diseases, behavioral health, substance use counseling and a host of specialty services including cardiology, podiatry, endocrinology, dermatology, among others. We operate more than 90 sites across San Diego County, including 29 primary care clinics, 23 behavioral health facilities, 10 physical rehabilitation clinics, nine dental clinics, five vision clinics, four outpatient substance use treatment programs, three mobile medical units, two mobile counseling centers, two urgent care centers, and a pharmacy.
PACE Medical Director of Resource Management (Part Time - 20 hours/week) San Ysidro Health CenterPACE Medical Director of Resource Management (Part Time - 20 hours/week)San Diego, CAPeer-to-Peer: Lead discussions with PACE Site Medical Directors, Primary Care Providers and other PACE staff and external network and non-contracted providers to direct appropriate levels of care, and to support high quality of care with timely and accurate documentation. Other principal responsibilities of the role shall be to provide clinical expertise to Health Plan Operations in the form of strategic partnership as well as in the addressing of escalations that include admission status determinations, delays in discharge and the providing of clinical input for denial management, and effective, cost-conscious primary and specialty care in the outpatient setting.
Pace Medical Director Of Resource Management (Part Time - 20 Hours/Week) San Ysidro Health CenterPace Medical Director Of Resource Management (Part Time - 20 Hours/Week)San Diego, CAEssential Functions of the Job: Determines appropriateness and medical necessity of health care services provided to San Diego PACE members including identifying patterns in care and supporting interventions to reduce unnecessary admissions or extended staysSupports San Diego PACE resource management program and accompanying action plan(s), which includes strategies to ensure high-quality participant care - that participant members receive the most appropriate care in the most effective setting and in a timely manner- Right Care, Right Place, Right Time. Clinical Review: Conduct or direct timely medical necessity determinations for outpatients, inpatient admissions and post-acute settings and services (SNF, ALF, LTACH, Palliative and Hospice Care and Home Health).Criteria Application: Use San Diego PACE Best Practices evidence-based guidelines, InterQual and CMS criteria to assess the appropriateness of acute care services.
Sr. Manager, Salesforce Customer Experience Management Veracyte IncSr. Manager, Salesforce Customer Experience ManagementSan Diego, CA$177,000–$198,000 / yearOur Veracyte Diagnostics Platform delivers high-performing cancer tests that are fueled by broad genomic and clinical data, deep bioinformatic and AI capabilities, and a powerful evidence-generation engine, which ultimately drives durable reimbursement and guideline inclusion for our tests, along with new insights to support continued innovation and pipeline development. This role sits within the Salesforce Engineering team and is ideal for a highly technical, seasoned leader with deep expertise in Salesforce Experience Cloud, strong knowledge of Sales Cloud and Marketing Cloud, and a practical understanding of UI/UX principles.
NewDirector, Product Management, Integrated Clinical Solutions IlluminaDirector, Product Management, Integrated Clinical SolutionsSan Diego, CA$187,400–$281,000 / yearThis senior product management leader will set the vision and evolve the strategy, roadmap, and business plan for a complex offering spanning instrumentation, software, and assay content, with a focus on delivering a compelling, end-to-end solution to decentralized clinical customers. Illumina is seeking a Director, Product Management, Integrated Clinical Solutions to define and drive cohesive product strategy and lifecycle management for an integrated clinical solution within the Clinical Solutions portfolio.
Utilization Management Nurse, Senior- Medicare Concurrent Review Blue Cross and Blue Shield AssociationUtilization Management Nurse, Senior- Medicare Concurrent ReviewSan Diego, CARequires a current California RN License Requires at least 5 years of prior relevant experience Requires strong communication and computer navigation skills Desires strong teamwork and collaboration skills Requires independent motivation and strong work ethic Requires strong critical thinking skills Hybrid Virtual Work This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need. Your Work In this role, you will: Perform prospective, concurrent and retrospective utilization reviews and first level determination approvals for members using BSC and CMS evidenced based guidelines, policies and nationally recognized clinal criteria for BSC Medicare line of business.
Project Delivery Management Engineer (Third party FMS) Deloitte Touche Tohmatsu LtdProject Delivery Management Engineer (Third party FMS)San Diego, CA$102,800–$171,300 / yearThis compensation range is specific to California and takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. As a PROJECT - Delivery Management Engineer III on the Government & Public Services team, you will be responsible for: Providing Security Cooperation support across the full case lifecycle for Foreign Military Sales and Building Partner Capacity activities.
Clinical Resource Management Assisitant Palomar HealthClinical Resource Management AssisitantEscondido, CaliforniaWindows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job. Under the direction of the Clinical Resource Management (CRM) team member (RN, SW) responsible to make referrals to post-acute care providers and suppliers of durable medical equipment.
Utilization Management Medical Director - Medical Oncology - Remote Anywhere In US UnitedHealth Group Inc.Utilization Management Medical Director - Medical Oncology - Remote Anywhere In USSan Diego, CARemote$248,500–$373,000 / yearServe as a subject matter expert in evidence - based oncology guidelines, especially those produced by the National Comprehensive Cancer Network (NCCN), and help ensure all clinically relevant policies and processes are informed by the best available evidence. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role.
Pain Management Nurse Practitioner or Physician Assistant (Np/pa) ESRhealthcare and EXEC STAFF RECRUITERSPain Management Nurse Practitioner or Physician Assistant (Np/pa)San Diego, CaliforniaDuties/Responsibilities of Pain Management Nurse practitioner or Physician assistant (NP/PA): Conduct comprehensive patient evaluations including history, physical exams, and review of diagnostic studies. Minimum 1-2 years of clinical experience preferred (pain management, orthopedics, neurology, anesthesia, or related field).
Social Services Director Pala Band Of Mission IndiansSocial Services DirectorCAPerforms activities and duties as required by SAMHSA grants and other Grants Agencies Tracks grant allocation, ensures programs comply with Federal, State, and Local regulations, maintains records, and prepares reports for senior management and tribal committee. Title: Social Services Director Department: Social Services Status: Full-Time Salary: Annual Salary / Exempt Supervisor: Tribal Chairperson Subordinates: Program Managers, Social Workers, Case Managers, Outreach Specialist, Grants Specialist, Admin Assistant.
Hospice Social Services Manager Hospice of the North CoastHospice Social Services ManagerCarlsbad, CAFull timeSocial Services Manager - Full Time - This is not a Remote PositionPOSITION SUMMARY:The Social Services Manager fills a management position with both clinical and management responsibility for his/her team; serves as liaison to and conduit between the Director of Patient Care Services, clinical staff on his/her respective team, patients and their families, and the community. Reports to:Director of Patient Care ServicesSupervises:Social Workers & Spiritual CounselorsQUALIFICATIONS:Education:Masters degree in Social Work or Marriage and Family Therapy from a school accredited by the Council on Social Work EducationCredentials:Certified, licensed, or registered as appropriate.
Social Worker II Clinical Lead LCSW (Full Time) Aurora San DiegoSocial Worker II Clinical Lead LCSW (Full Time)San Diego, CA$83,200–$99,840The Clinical Lead will actively participate in the multi-disciplinary treatment team to support program philosophy, deliver quality psychotherapeutic services to psychiatric patients and families, while prioritizing patient safety and well-being. The Clinical Lead will assist the Director of Social Services in overseeing Associate Clinicians who are accruing supervised clinical hours toward Social Work licensure with the California Board of Behavioral Sciences (BBS).
Adult Housing Services Manager San Diego LGBT Community CenterAdult Housing Services ManagerSan Diego, CA$27–$28 / hourFull timePOSITION SUMMARYReporting to the Director of Adult Housing Services, the Adult Housing Services Manager oversees The Center's expanding LGBTQ-affirming wraparound and support services for adults who are currently experiencing homelessness or at risk of homelessness. Professional Experience: 3 or more years of experience providing case management, housing navigation, and/or wrap-around services to people experiencing homelessness or at risk of homelessness.2 or more years of experience providing staff supervision and support.
Entry Level Social Work Social Impact ServicesEntry Level Social WorkVISTA, CAFull timeExperience working with individuals with developmental disabilities, preferably in a case management or direct support role is a plus but not required; training is provided upon hire with a dedicated leadership team. Collaborate with community partners, service providers, and healthcare professionals to enhance the overall support network for clients.
Hcba Waiver Medical Social Worker, MSW San Ysidro Health CenterHcba Waiver Medical Social Worker, MSWSan Diego, CAExperience and Required Skills:A minimum 2 years of any combination of the below: 2 years of experience working in a managed care health plan or2 years of experience in utilization review, case management, and/or discharge planning or2 years of experience in transitional care and acute care settings (critical care, acute hospital care, long term acute care, skilled nursing care, long term care).Must thrive within a team environment, possess good organizational skills, and can effectively handle difficult and unusual interpersonal situations. Position Summary:Reporting to the HCBA Waiver Manager, and as a member of the Care Management Team, the Social Worker supports the development and monitoring of the plan of treatment for a caseload of Home and Community Based Alternatives Waiver Program participants and provides community-based (in-home, telehealth, and telephonic) evaluation of services to ensure the health, safety, and well-being of vulnerable and high-risk populations.