OTHER

FEED

UNKNOWN

Ability to practice autonomously in a remote clinical environment, including independently conducting patient assessments, formulating evidence-based treatment plans, managing complex chronic conditions, and making soundclinical decisions without direct on-site supervision. Pay Range: $2,400.00 - $10,000.00 per month (Potential income) Earnings will vary based on completed assessments, state of residence, and business needs as there is no guarantee of visits or minimum income.

YEAR

Overview:
Nurse Practitioner Per DiemThis position covers all zip codes in: Santa Cruz County,  CA ComplexCare Solutions (CCS) specializes in helping those in need by delivering high-value home and virtual assessments for health plans nationwide. We pride ourselves on our member engagement aimed towards evaluating current health status, gaps in care, potential health risks and care management opportunities with a focus on driving better clinical outcomes. CCS, on behalf of SME Medical Delaware, P.A., is calling on Advanced Practice Providers that are passionate about helping their local communities. We care dearly about those whom we serve, and we need your help to make a difference in the lives of our members. Providers have the opportunity to spend a full hour with these members, which allows them to capture a comprehensive picture of that individual’s personal needs and what is required to keep them in the home and out of the hospital. Compensation:<ul><li style="margin:0in">Pay Range: $2,400.00 - $10,000.00 per month (Potential income) Earnings will vary based on completed assessments, state of residence, and business needs as there is no guarantee of visits or minimum income</li><li style="margin:0in">In-home visit rate: $120 - $140 depending on state of residence</li><li style="margin:0in">If available, our telehealth rate is $85 per completed assessment</li></ul>Benefit:This position is eligible to participate in a company 401K plan providing the opportunity to save for retirement through employee contributions. New hires will be automatically enrolled in the company 401(k) plan at a 3% contribution rate with the option to opt out.

Responsibilities:
<ul><li>Knowledge of CMS Regulations and NCQA HEDIS Guidelines</li><li>Knowledge of Evidence-based Clinical Practice Standards: American Diabetes Association (ADA), American College of Cardiology (ACC), American Heart Association (AHA), Familiarity with ICD-10 and CPT-4 coding practices</li><li>Complete comprehensive, accurate and thorough review of the assigned member population, including timely completion and submission of all required encounter documentation (paper or electronic)</li><li>Ensure that all pertinent and active medical conditions are documented in the medical record in a manner compliant with CMS/DHHS, Company policy, and client requirements</li><li>Support the physician/patient relationship and ensure timely and adequate communication, documentation of assessment findings, recommendations, need for additional services, emergency services required if necessary and need for follow up and timelines for follow up to primary care provider (PCP) and health plan as required</li><li>Make general recommendations to members intended to improve members' knowledge of their chronic condition(s), such as information concerning recommended testing</li><li>Address and close identified gaps in care (disease-specific or preventive)</li><li>Recognize emergent or urgent situations requiring escalation and take appropriate action as specified in company policies, and as determined by reasonable professional judgment and ethical professional practice standards; and</li><li>Perform, document and communicate results of Point of Care (POC) Testing</li><li>Maintain compliance with Company policies, procedures and mission statement</li><li>Adhere to all confidentiality and HIPAA requirements as outlined within the Company’s Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position</li><li>Fulfill those responsibilities and/or duties that may be reasonably provided for the purpose of achieving operational and financial success of the Company</li><li>Uphold responsibilities relative to the separation of duties for applicable processes and procedures within your job function</li><li>On a monthly basis, be available for a minimum of 25 slots of availability per month (approximately 37 hours)</li><li>We reserve the right to change this job description from time to time as business needs dictate and will provide notice of such</li><li>Other duties as assigned</li></ul>

Qualifications:
<ul style="margin-top:0in"><li>Active un-encumbered license to practice nursing</li><li>ANCC or AANP board certification as a Nurse Practitioner or Clinical Nurse Specialist in Family, Adult, Gerontology or Emergency Medicine. </li><li>Maintains current CPR certification</li><li>Compliance, prior to hire, with recommended Healthcare Personnel Requirements for vaccinations and preventive testing:</li><li><ul style="margin-top:0in"><li>Hepatitis B</li><li>Influenza</li><li>MMR: Measles, Mumps and Rubella</li><li>Pertussis, Tetanus and diphtheria and acellular pertussis (Tdap)</li><li>Varicella</li><li>Tuberculosis</li></ul></li><li>Home Health exp a plus </li><li>Must be able to effectively communicate with elderly and chronically ill patients and families</li><li>Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial</li><li>Ability to multitask</li><li>Excellent customer service skills</li><li>Bi-lingual or multi-lingual a plus</li><li>Ability to practice autonomously in a remote clinical environment, including independently conducting patient assessments, formulating evidence-based treatment plans, managing complex chronic conditions, and making soundclinical decisions without direct on-site supervision</li><li>Proficient with computer platforms, electronic health records (EHRs), secure messaging systems, and cloud-based documentation tools</li></ul>This company utilizes E-Verify. ComplexCare Solutions (CCS) is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status. By embracing diversity, equity and inclusion we enhance our work environment and drive business success. ComplexCare Solutions (CCS) strives to reflect the diversity of the communities where we operate and of our clients and everyone whom we serve. We endeavor to create a culture of inclusion in which our associates feel empowered to bring their full, authentic selves to work and pursue their professional goals in an equitable setting. We understand that by fostering this type of culture, and welcoming different perspectives, we generate innovation and growth.

ComplexCare Solutions

Nurse Practitioner (Per Diem)

American Nurses Credentialing Center (ANCC)

CPR Certification

Cardiology

Centers for Medicare and Medicaid Services (CMS)

Certified Coding Specialist (CCS)

Clinical Nursing

Clinical Outcomes

Clinical Practices/Protocols

Cloud Computing

Communication Skills

Computer Skills

Computer Systems

Content Management Systems (CMS)

Corporate Policies

Current Procedural Terminology (CPT)

Customer Support/Service

Department of Health and Human Services

Diabetes

Disease

Diversity

Documentation

Emergency Medicine

Emergency Services

Equal Employment Opportunity (EEO)

HIPAA (Health Insurance Portability and Accountability Act)

Health Plan

Healthcare

Healthcare Effectiveness Data and Information Set (HEDIS)

Hepatitis B

Home Care

Hospital

ICD-10

Maintain Compliance

Medicaid

Medical Conditions

Medical Record System

Medical Records

Medicare

Messaging Technology

Multilingual

Multitasking

National Committee for Quality Assurance (NCQA)

Nurse Practitioner

Nursing Credentials

Operations Processes

Patient Assessment

Primary Care

Regulations

Risk Management

Staff Requirements

Telehealth

Time Management

Treatment Plan

[AW]-iCims

Our practices include Barnet Dulaney Perkins Eye Center, Southwestern Eye Center, Retinal Consultants of Arizona, M&M Eye Institute, Abrams Eye Institute, Southwest Eye Institute, Aiello Eye Institute, Moretsky Cassidy Vision Correction, Wellish Vision Institute, West Texas Eye Associates and Vantage Eye Center. Company Intro: At American Vision Partners (AVP), we partner with the most respected ophthalmology practices in the country and integrate best-in-class management systems, operational infrastructure, and advanced technology to provide the highest quality patient care possible.

Company Intro:
At American Vision Partners (AVP), we partner with the most respected ophthalmology practices in the country and integrate best-in-class management systems, operational infrastructure, and advanced technology to provide the highest quality patient care possible. Our practices include Barnet Dulaney Perkins Eye Center, Southwestern Eye Center, Retinal Consultants of Arizona, M&M Eye Institute, Abrams Eye Institute, Southwest Eye Institute, Aiello Eye Institute, Moretsky Cassidy Vision Correction, Wellish Vision Institute, West Texas Eye Associates and Vantage Eye Center. We are focused on building the nation’s largest and most comprehensive eye care practices and currently operate more than 100 eye care centers in Arizona, New Mexico, Nevada, California and Texas – including 25 ambulatory surgical centers. At AVP we value teamwork, providing exceptional experiences, continuous improvement, financial strength, and hard work. We are committed to providing best-in-class patient care, pioneering research and technology, and most importantly, rewarding and recognizing our employees!

Overview:
This position verifies insurance coverage, benefits and obtains prior authorization for services. 

Responsibilities:
MAIN:<ol><li style="font-size:12pt">Contacts insurance plans to determine eligibility and obtain coverage and benefit information.</li><li style="font-size:12pt">Obtains prior authorization for services.</li><li style="font-size:12pt">Processes requests for prior authorization for surgery and/or procedure injections</li><li style="font-size:12pt">Identifies and resolves problems with participant eligibility/insurance coverage</li><li style="font-size:12pt">Accurately calculates patient responsibility amounts based on benefit information and payer allowable.</li><li style="font-size:12pt">Documents findings thoroughly and accurately.</li><li style="font-size:12pt">Prioritizes work to maximize turn-around time.</li><li style="font-size:12pt">Meets or exceeds productivity standards in the completion of daily assignments and accurate production.</li><li style="font-size:12pt">Maintain an error rate in accordance with departmental policy.</li><li style="font-size:12pt">Makes changes to demographic information as necessary in order to produce a clean patient statement.</li><li style="font-size:12pt">Answer and respond to external and internal phone calls in a timely manner.</li><li style="font-size:12pt">Check and respond to emails in a timely and professional manner.</li><li style="font-size:12pt">Performs all other assigned duties.</li></ol> GENERAL DUTIES:<ol start="13"><li style="font-size:12pt">Conducts self in accordance with the company’s standard values and policies.</li><li style="font-size:12pt">Participates in a variety of educational programs, corporate and professional, to maintain current skill and competency levels.</li></ol> The Essential Job Functions and Duties and Responsibilities listed above are not exhaustive.  The job functions and duties of this job may vary depending upon the specific nature and needs of the department, including size, location and services offered.  At some locations, employees may not perform all of the job functions or duties listed above.  At other locations, employees may perform some or all of the job functions or duties listed above and, in addition, may be required to perform other job functions or duties as directed. In addition, given the nature of its business, MMRG retains the right to modify the essential job functions and duties of this position at any time. METHOD AND FREQUENCY OF SUPERVISION: <ul><li style="font-size:12pt">Monthly meetings with supervisor. Informal supervision with employee through an open door policy.  Employee is expected to ask questions when needed. </li></ul> 

Qualifications:
Education: <ul><li style="font-size:12pt">High School diploma or equivalent </li></ul> Prior Experience: <ul><li style="font-size:12pt">Minimum of 1-2 years of insurance verification, referrals, prior authorization, or eligibility experience required experience preferred.</li></ul> Skills and Proficiencies: <ul><li style="font-size:12pt">Active knowledge of CMS guidelines contracted insurance guidelines and coding policies.</li><li style="font-size:12pt">Demonstrated computer literacy</li><li style="font-size:12pt">Well-organized with attention to detail</li><li style="font-size:12pt">Ability to read and understand oral and written instructions</li><li style="font-size:12pt">Excellent math skills</li><li style="font-size:12pt">Critical thinking skills are strongly preferred</li><li style="font-size:12pt">Ability to establish and maintain effective working relationship with team members, clinic staff, payers and patients.</li><li style="font-size:12pt">Professional customer service skills.</li><li style="font-size:12pt">Have a desire and dedication to work with self-discipline.</li><li style="font-size:12pt">Maintains the strictest confidentiality: adheres to all HIPAA guidelines and regulations.</li></ul> Physical Abilities: <ul><li style="font-size:12pt">Ability to sit for long periods. Work requires walking, bending, standing, sitting, and reaching</li></ul> 

Benefits & Perks:
Your health, happiness and your future matters! At Vantage Eye Center, we offer everything from medical and dental insurance, significant eye care discounts, child care assistance, pet insurance, continuing education funds, 401(k), paid holidays, PTO, Sick Time, opportunity for growth, and much more!

American Vision Partners

Authorization Specialist

Continuous Improvement

Demographics

Detail Oriented

Identify Issues

Injections

Insurance

Mathematics

Ophthalmology

Organizational Skills

Patient Care

Problem Solving Skills

System Operations

Team Player

Technical Research

This role sits between the working level (Analyst II) and the expert level (Analyst IV), focusing on technical execution, vendor integration, and providing guidance to junior staff while supporting tactical plan projects. Experience: * 5+ years of experience in product configuration, provider payments, and member benefits (or a Master's degree + 3 years).3+ years of experience specifically within a Managed Healthcare environment.

We are seeking an Application Analyst III – Core Systems (HSP) to join a dynamic Application Services team. This is an advanced working-level position responsible for performing highly complex systems configuration tasks. You will provide high-level support for research, analysis, and the implementation of State policies and procedures within core health systems.This role sits between the working level (Analyst II) and the expert level (Analyst IV), focusing on technical execution, vendor integration, and providing guidance to junior staff while supporting tactical plan projects.<h3>What You Will Do</h3><ul><li>System Configuration & Support: Provide medium- to high-level expertise in system configuration, troubleshooting, and resolving issues related to core systems and internal integrations.</li><li>Vendor & Integration Management: Assist with the integration of new vendors and assess software bugs or change requests to help leadership prioritize development needs.</li><li>Policy Implementation: Assist in interpreting and implementing operational changes from regulatory bodies such as DHCS, DMHC, and CMS.</li><li>Analysis & Reporting: Evaluate complex departmental workflows and procedures, conduct research, and recommend improvements. Generate routine operational reports for leadership review.</li><li>Project Collaboration: Assist in defining project scopes and goals. Develop functional specifications and use cases for Quality Assurance, User Acceptance Testing (UAT), and Release Management.</li><li>Training & Mentorship: Provide technical guidance to Application Services staff. Design and deliver training content on core systems in collaboration with the Learning and Development Department.</li></ul><h3>You Will Be Successful If</h3><ul><li>Technical Knowledge: You have a solid understanding of the software product lifecycle, information management, and the principles of software development and integration.</li><li>Healthcare Expertise: You possess working knowledge of the Medicaid Program, national diagnostic coding, and product configuration within a Medicaid/Medicare environment.</li><li>Analytical Skills: You can translate business requirements into detailed product requirements and identify problems that require escalation.</li><li>Communication: You can adjust your communication style to facilitate collaboration between technical and non-technical audiences.</li><li>Organization: You can manage multiple projects simultaneously, maintain accurate records, and meet strict timelines with minimal supervision.</li></ul><h3>What You Will Bring</h3><ul><li>Education: Bachelor's degree in Business Administration, Healthcare, IT, Information Science, or a related field.</li><li>Experience: * 5+ years of experience in product configuration, provider payments, and member benefits (or a Master's degree + 3 years).<ul><li>3+ years of experience specifically within a Managed Healthcare environment.</li><li>MANDATORY: Hands-on experience with HSP/Meditrac claims processing systems.</li><li>MANDATORY: Direct experience in Product, Provider Payments, and Member Benefits configuration.</li></ul></li><li>Specialized Knowledge: Thorough understanding of health care regulatory policies, Medi-Cal, and health care data analytics.</li><li>Desired Pluses: * D-SNP experience (Highly Preferred).<ul><li>Proficiency in SharePoint.</li><li>Knowledge of Agile/Scrum and Application Lifecycle Management (ALM).</li></ul></li></ul>

HJ Staffing

Application Analyst III - Core Systems (HSP)

Acceptance Testing

Agile Programming Methodologies

Analysis Skills

Bug Tracking Software

Business Administration

Change Requests/Orders

Claims Processing

Data Analysis

Establish Priorities

Health Information Technology

Healthcare Management

Information Science

Leadership

Managed Care

Medi-Cal

Medical Coding

Mentoring

Microsoft SharePoint

People Management

Policy Implementation

Product Lifecycle Management

Project Planning

Project/Program Management

Quality Assurance

Record Keeping

Release Management/Engineering

Requirements Management

Research Skills

Scrum Project Management and Software Development

Software Development

Software Development Lifecycle (SDLC)

Strategic Planning

System Integration (SI)

Systems Administration/Management

Technical Leadership

Testing

Training/Teaching

Training/Teaching Materials

Use Cases

Vendor/Supplier Selection

Workflow Analysis

BreezyHR

As a Registered Nurse with Best Home Health Providers, you will play a key part in ensuring the accuracy and quality of clinical documentation, helping our patients receive the right care at the right time. If you are passionate about making a positive impact in patients' lives and working in a supportive and family-oriented atmosphere, we encourage you to join us in providing exceptional home health care.

At Best Home Health Providers Inc., we've gone from treating 10 patients to thousands of patients all throughout the Bay Area and beyond in just 6 years. We've won awards for our high-quality care with patients and continue to grow rapidly. At Best, you and the patients aren't a number. Our mission is to ensure a smooth transition for patients returning home from medical facilities by offering expert guidance throughout their recovery journey. As a Registered Nurse with Best Home Health Providers, you will play a key part in ensuring the accuracy and quality of clinical documentation, helping our patients receive the right care at the right time. You’ll collaborate closely with clinical staff, contribute to quality improvement initiatives, and help uphold our commitment to regulatory compliance. We value teamwork, empathy, and a commitment to high-quality service, all aimed at putting patients and their families at ease during their recovery. If you are passionate about making a positive impact in patients' lives and working in a supportive and family-oriented atmosphere, we encourage you to join us in providing exceptional home health care.Please note that this role is per diem with a rate of $110 - $130 per visit.<h3>Responsibilities</h3><ul><li>Review OASIS assessments for completeness, appropriateness, and compliance with federal and state regulations.</li><li>Ensure accurate ICD-10 coding and sequencing based on each patient’s medical condition and co-morbidities.</li><li>Partner with clinical staff to resolve documentation and data integrity issues.</li><li>Monitor visit utilization and flag potential financial risks or underutilization to clinical management.</li><li>Identify and communicate trends that impact agency outcomes and process measures.</li><li>Conduct OASIS inter-rater reliability visits with clinical team members.</li><li>Participate in Quality Improvement and Corporate Compliance activities.</li><li>Stay current with best practices through ongoing education and professional development.</li><li>Perform other duties as required for patient services.</li></ul>Requirements<ul><li>Active Californian RN license in good standing.</li><li>1–2 years of clinical home health experience.</li><li>Working knowledge of OASIS assessments and ICD-10 coding.</li><li>Knowledge of federal regulations and state licensure requirements.</li><li>Strong communication skills and a keen eye for detail.</li><li>Ability to work independently and manage priorities with minimal supervision.</li><li>Proficiency with computer systems and electronic health records.</li><li>Current CPR certification with AHA.</li><li>Valid driver’s license, reliable insured vehicle.</li></ul>Nice to Have<ul><li>OASIS certification (COS-C).</li><li>OASIS Home Health ICD-10 coding certification.</li></ul>Benefits<ul><li>Flexible Schedule</li><li>Ability to Convert to Full-Time Based On Performance If Interested </li><li>Paid Sick Days</li><li>Paid Bereavement Leave</li><li>Skills Training & Development</li><li>Company Social Events</li><li>Mileage Reimbursement for Patient to Patient Visits</li><li>Referral Bonus</li></ul>

Best Home Health Providers, Inc.

Registered Nurse

Best Practices

Clinical Study Publications

Corporate Compliance

Data Quality

Driver's License

Federal Laws and Regulations

Financial Risk

Healthcare Providers

Healthcare Quality

Medical Treatment

Quality Management

Registered Nurse (RN)

Regulatory Compliance

Reimbursement

State Laws and Regulations

Trend Analysis

Workable

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Nurse Practitioner (Per Diem)ComplexCare Solutions

Authorization SpecialistAmerican Vision Partners

Application Analyst III - Core Systems (HSP)HJ Staffing

Registered NurseBest Home Health Providers, Inc.

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