Utilization Management - RN Impresiv HealthUtilization Management - RNLong Beach, CARemoteIn this role, you will perform concurrent reviews, prior authorizations, medical necessity reviews, discharge planning, and transitions of care while collaborating with physicians, hospitals, and interdisciplinary teams to ensure members receive appropriate, cost-effective, and evidence-based care. Impresiv Health is a healthcare consulting partner specializing in clinical and operations management, enterprise project management, professional services, and software consulting services.
Prior Authorizations Nurse (RN) (Temporary) Central California Alliance for HealthPrior Authorizations Nurse (RN) (Temporary)Los Angeles, CARemote$52–$57.50 / hourAssociate's degree in Nursing and a minimum of five years of experience in a patient care setting which included a minimum of one year of experience in Utilization Management or Case Management (a Bachelor's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying. Final compensation will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education, or training), as well as other factors (internal equity, market factors, and geographic location).
Senior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (Remote) (Exempt) (Non-Union) University of Southern CaliforniaSenior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (Remote) (Exempt) (Non-Union)Alhambra, CARemote$99,507–$130,000 / yearThe Senior RI Specialist also coordinates with Keck Medical Center of USC Administration, IS, Compliance, Clinical Informatics and Integration personnel on technology projects impacting charge entry, charge dictionaries, and charge, and provides data derived from multiple entities of Keck Medical Center of USC for the management and support of critical decisions and functions related the Chargemaster, CDM Maintenance, and the improvement of charge capture. As a subject matter expert in the area of compliance and pricing of services, the Senior RI Specialist responds to inquiries regarding Chargemaster issues and is responsible for supervising meetings for projects associated with educating and communicating to clinical revenue generating departmental staff regarding the CDM Maintenance process, coding updates, compliance issues, and charge capture improvement.
Senior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (REMOTE) (Exempt) (Non-Union) University of Southern CaliforniaSenior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (REMOTE) (Exempt) (Non-Union)Alhambra, CaliforniaRemoteThe Senior RI Specialist also coordinates with Keck Medical Center of USC Administration, IS, Compliance, Clinical Informatics and Integration personnel on technology projects impacting charge entry, charge dictionaries, and charge, and provides data derived from multiple entities of Keck Medical Center of USC for the management and support of critical decisions and functions related the Chargemaster, CDM Maintenance, and the improvement of charge capture. As a subject matter expert in the area of compliance and pricing of services, the Senior RI Specialist responds to inquiries regarding Chargemaster issues and is responsible for supervising meetings for projects associated with educating and communicating to clinical revenue generating departmental staff regarding the CDM Maintenance process, coding updates, compliance issues, and charge capture improvement.
Technical Business Analyst The Ensign Group IncTechnical Business AnalystIrvine, CARemote$95,000–$121,000 / yearESI is known as the Service Center and provides the facilities and leaders it serves with back-office support in areas such as accounting, construction, compliance, human resources, information technology, learning and development, legal and risk management and recruiting. Automation is a wide-ranging discipline focused on improving business operations through technology in any form - software development, system integration, workflow platforms, AI, data solutions, and process redesign.
NewCare Coordinator / LA West Coast UCB SACare Coordinator / LA West CoastLos Angeles, CARemote$88,000–$115,500 / yearUsing your clinical experience and behavioral science skills, you will help patients and caregivers navigate barriers, identify relevant resources, and communicate confidently with their healthcare providers. This is a remote position aligned with West Coast working hours (PST) supporting Spanish- and English-speaking patients and caregivers throughout their treatment journeys.
NewRevenue Cycle Auditor RN - Revenue Integrity - Full time, Day, Remote Providence St. Joseph HealthRevenue Cycle Auditor RN - Revenue Integrity - Full time, Day, RemoteIrvine, CARemoteTogether, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
NewRevenue Cycle Auditor RN - Revenue Integrity - Full time, Day, Remote Providence Health & ServicesRevenue Cycle Auditor RN - Revenue Integrity - Full time, Day, RemoteIrvine, CARemoteRequsition ID: 457901 Company: Providence Jobs Job Category: Revenue Cycle Operations Job Function: Revenue Cycle Job Schedule: Full time Job Shift: Day Career Track: Nursing Department: 4001 SS RC REV INTEGRITY Address: CA Irvine 15480 Laguna Canyon Rd Work Location: Providence System Offices Discovery Park-Irvine Workplace Type: On-site Pay Range: $See Posting - $See Posting The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
RN Utilization Review - Per Diem - REMOTE Providence St. Joseph HealthRN Utilization Review - Per Diem - REMOTEIrvine, CARemoteThe Utilization Management RN must effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment, demonstrating excellent negotiation, communication, problem-solving, and decision-making skills. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
RN Utilization Review - Per Diem - REMOTE Providence Health & ServicesRN Utilization Review - Per Diem - REMOTEIrvine, CARemote$57.28–$88.92 / hourRequsition ID: 434193 Company: Providence Jobs Job Category: Health Information Management Job Function: Revenue Cycle Job Schedule: Part time Job Shift: Multiple shifts available Career Track: Nursing Department: 7000 UTILIZATION MGMT OCHD Address: CA Irvine 15480 Laguna Canyon Rd Work Location: Providence System Offices Discovery Park-Irvine Workplace Type: On-site Pay Range: $57.28 - $88.92 Our not-for-profit network provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care, and even our own Providence High School.
NewUtilization Review RN Providence St. Joseph HealthUtilization Review RNIrvine, CARemoteThe Utilization Management RN must effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment, demonstrating excellent negotiation, communication, problem-solving, and decision-making skills. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
NewUtilization Review RN Providence Health & ServicesUtilization Review RNIrvine, CARemote$57.28–$88.92 / hourRequsition ID: 456937 Company: Providence Jobs Job Category: Health Information Management Job Function: Revenue Cycle Job Schedule: Part time Job Shift: Day Career Track: Nursing Department: 7000 UTILIZATION MGMT OCHD Address: CA Irvine 15480 Laguna Canyon Rd Work Location: Providence System Offices Discovery Park-Irvine Workplace Type: Remote Pay Range: $57.28 - $88.92 Our not-for-profit network provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care, and even our own Providence High School.
Technical Business Analyst Ensign ServicesTechnical Business AnalystIrvine, CaliforniaRemoteESI is known as the Service Center and provides the facilities and leaders it serves with back-office support in areas such as accounting, construction, compliance, human resources, information technology, learning and development, legal and risk management and recruiting. As part of this team, the Technical Business Analyst will translate complex business needs into actionable technical requirements and partner closely with developers and stakeholders to deliver high-impact solutions.
Bilingual Korean Nurse Care Planner - RN SHPCA SCAN Health PlanBilingual Korean Nurse Care Planner - RNLos Angeles, CaliforniaRemote$38.61–$61.78 / hourIncrease knowledge by keeping current on Medicare and Medi-Cal policies, Federal and State legislation affecting health and social services, maintaining updated community resource information, attending trainings as scheduled, actively participating in supervision, and striving to improve professionally. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.
Bilingual Korean Nurse Care Planner - RN SCAN Health PlanBilingual Korean Nurse Care Planner - RNLos Angeles, CaliforniaRemoteIncrease knowledge by keeping current on Medicare and Medi-Cal policies, Federal and State legislation affecting health and social services, maintaining updated community resource information, attending trainings as scheduled, actively participating in supervision, and striving to improve professionally. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.
NewRN, Care Management (SCAN Temp) SCAN Health PlanRN, Care Management (SCAN Temp)Los Angeles, CaliforniaRemote$50–$55 / hourPerform nursing related Enhanced Care Management (ECM) activities related to specific Populations of Focus (POF): Individuals Experiencing Homelessness, Individuals At Risk For Avoidable Hospital Or ED Utilization, Adults Living In The Community At Risk Of LTC Institutionalization, Adult Nursing Facility Residents Transitioning Back To The Community. Perform initial and annual telephonic assessments in conjunction with a Community Health Worker for Medi-Cal/Medicare dually eligible members referred to Care Coordination for Long-Term Services and Supports (LTSS) and in determining Nursing Facility Level of Care.
Clinical Care Transition Educator / RN - Part Time, Remote Option Care Health IncClinical Care Transition Educator / RN - Part Time, RemoteLos Angeles, CARemote$46.60–$77.67 / hourEvaluate, educate, and train patients, caregivers, and facility staff about how OCH services & products will be facilitated in an alternative site, in-home, or virtually in order to ensure successful transition of patients to an Option Care Health delivery model. 100% local travel to and from partnerships facilities, community hospitals, and medical practice offices to sell Option Care Services, process referrals and provide live education and training support to patient/caregiver and referral sources.
Network Compliance Auditor, FSR SCAN Health PlanNetwork Compliance Auditor, FSRLong Beach, CaliforniaRemoteConducts closing meetings with audited providers to give them a preliminary overview of completed compliance audits Assists providers in achieving and maintaining compliance with SCAN, Federal, State and NCQA requirements and guidelines including the development and implementation of corrective action plans (CAP), monitoring CAP activities and providing education and tools Responds to audited providers as disagreements with audit findings arise Analyzes submitted reports from providers, including the request for corrections from providers as needed Communicates regulation interpretations and explains their application, provides supplemental information if needed Conducts detailed review, analysis, and interpretation of legislative, statutory, regulatory, and contract language. Conducts all aspects of annual oversight projects, individual correspondence; coordination of projects with internal SCAN staff and departments; monitoring and reporting delegated compliance; tracking, trending and reporting upon project status; coordinating with Compliance regarding report submissions and regulatory updates Uses critical thinking skills and identifies impactful areas for provider data requirements to develop an effective implementation and communication plans.
RN Health Care Facility Surveyor Greenlife Healthcare StaffingRN Health Care Facility SurveyorLos Angeles, CARemote$75,000–$90,000 / yearThe Surveyor will serve as a team member or team leader on various types of surveys (i.e. re-certification, comparative, complaint investigation, and revisits) for long-term care and non-long-term care surveys, which can include; ambulatory surgical centers (ASC), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID), end-stage renal disease (ESRD), Psychiatric Residential Treatment Facility (PRTF), hospital, critical access hospital, and hospice facilities. Impact Recruiting Solutions is currently seeking a RN Health Care Facility Surveyor to fill an opening with a Quality Improvement Consulting Company and will work in a technically exciting environment supporting internal and external customers nationwide.
Sr. Clinical Market Development Specialist (Los Angeles) Medtronic PlcSr. Clinical Market Development Specialist (Los Angeles)Los Angeles, CARemoteThe (CMDS) will work within their assigned territory with aligned sales partners to develop advocacy from Key Opinion Leaders, key clinical and business decision makers, generate demand for product evaluations, competitive conversions, drive key deals to closure, and support post-sales activities including implementation, education, in-servicing, ongoing support, and the development of robust reference accounts. Act as a key resource for and collaborate with other internal partners (e.g., Clinical Directors, Sales Leaders, Sales Partners, Marketing, Medical Affairs, R&D) on the following: Educate and update the organization quarterly on ICU/CVICU, OR/CVOR, NICU/PICU trends and customer needs.