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.
Clinical Care Transition Educator / RN - Part Time, Remote Option Care Health IncClinical Care Transition Educator / RN - Part Time, RemoteSanta Fe Springs, 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.