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.
RN Case Manager ExlService Holdings IncRN Case ManagerCARemote$75,000–$95,000 / yearThe goal of these activities is to help beneficiaries regain optimum health or improved functional capability, support effective self-care management, and promote access to healthcare services and community resources. Document identified issues, prioritized and individualized goals (long & short term), evidence-based interventions, collaborative approaches and resources, anticipated time frames, and barriers to achieving goals in the care plan.
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.
RN Care Navigator (100% Remote for candidates located in the PST & MST time zones) Healthmap Solutions IncRN Care Navigator (100% Remote for candidates located in the PST & MST time zones)CARemoteManaging a set caseload of mixed acuity members, reviewing and/or obtaining member data and entry in HealthMap's Care Management documentation system (Compass), completing member health and social determinants of health screenings, medication reconciliation, creation and maintaining member-centric care plans, updates of identified problems, barriers, interventions, and goals and assistance with ongoing case management. Serve as liaison between the patient, the patient's support network, treating physician, and other ancillary providers as a member of an interdisciplinary care team to coordinate care, resolve nursing problems and assist patients in meeting individualized goals.
RN Care Navigator/Case Manager (100% Remote for candidates able to work Pacific & Mountain time zones) Healthmap Solutions IncRN Care Navigator/Case Manager (100% Remote for candidates able to work Pacific & Mountain time zones)CARemoteManaging a set caseload of mixed acuity members, reviewing and/or obtaining member data and entry in HealthMap's Care Management documentation system (Compass), completing member health and social determinants of health screenings, medication reconciliation, creation and maintaining member-centric care plans, updates of identified problems, barriers, interventions, and goals and assistance with ongoing case management. Serve as liaison between the patient, the patient's support network, treating physician, and other ancillary providers as a member of an interdisciplinary care team to coordinate care, resolve nursing problems and assist patients in meeting individualized goals.
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.
NewClinical Documentation Reviewer, RN Welbe Health LLCClinical Documentation Reviewer, RNCalifornia, CARemote$99,309.58–$131,088.64 / yearReporting into Central ERD leadership, this position is accountable for conducting clinical reviews of prospective participant enrollment documentation to support consistent, accurate, compliant, and timely enrollment determinations across WelbeHealth markets. Identify cases requiring escalation or additional evaluation by Medical Directors, Executive Directors, PMHNPs, Social Workers, Pharmacists, Home Care team members, Facilities or delegates, Compliance team members, or other applicable stakeholders.
Care Manager RN Providence St. Joseph HealthCare Manager RNTorrance, 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. The Care Management Recovery Advocate (CMRA) is responsible for providing overall management and communication of clinically-based appeals between Providence Health and Services, California Region (PH&S) outside payers.
Care Manager RN - Utilization Management Providence St. Joseph HealthCare Manager RN - Utilization ManagementTorrance, 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. The Care Management Recovery Advocate (CMRA) is responsible for providing overall management and communication of clinically-based appeals between Providence Health and Services, California Region (PH&S) outside payers.
Telephonic Triage RN - Remote Call Center (PMs) Medcor IncTelephonic Triage RN - Remote Call Center (PMs)CARemoteTo preserve our pioneering, entrepreneurial spirit, we impart our values through the ongoing Better@Medcor campaign: encouraging our advocates to make a conscious choice to practice our values, to celebrate and recognize each other via our peer recognition program, and to support one another during tough times. Our nurses must be able to visualize an injury while on the phone and clarify details about the injury while following our propriety algorithms to guide the triage of the injured worker.
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.
Sr. Clinical Market Development Specialist (Los Angeles) MedtronicSr. Clinical Market Development Specialist (Los Angeles)Los Angeles, CaliforniaRemoteThe (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.
Independent 1099 Commission-Based Sales Representative WHITEROSE THREADS INCIndependent 1099 Commission-Based Sales RepresentativeLos Angeles, CARemoteFull timeCandidates who have experience using, selling, recommending, or educating providers about products such as PDO Threads, micro cannulas, skin boosters, dermal fillers, PRP, or other aesthetic products are especially encouraged to apply. Whiterose Threads is a medical device company that sells products to physicians, registered nurses (RNs), nurse practitioners (NPs), aesthetic injectors, medical spas, aesthetic clinics, and other qualified healthcare and aesthetic professionals.
Senior Medical Science Liaison - West Region SpringWorks Therapeutics IncSenior Medical Science Liaison - West RegionCARemote$167,500–$220,000 / yearMSL being able to develop and maintain an advanced scientific, medical, and product knowledge base, ability to communicate key insights learned, and disseminate critical scientific data to external stakeholders; including but not limited to academic/scientific/clinical experts, payers, and patient organizations. Essential Duties and Responsibilities: Identify Key Opinion Leaders (KOLs) and establish and maintain strong and deep scientific relationships with KOLs across multi-specialty disciplines, connecting to KOLs in academic centers and community practices at the local, regional, and national level.
Product Marketing Manager ProsperOps Inc.Product Marketing ManagerCARemoteProsperOps is the category leader in autonomous cloud cost optimization, founded by the leaders behind Rackspace's AWS Managed Services Business. We're looking for insanely curious individuals who have been through the build process at a startup or market analysts who are true subject matter experts in the cloud financial management space.
Manager, Sales Enablement - Learning Design Samsara Inc.Manager, Sales Enablement - Learning DesignCARemote$96,092.50–$129,200 / yearIn this role, you''ll set the strategy and quality bar for how Samsara designs, builds, and delivers learning experiences and sales content, while growing a talented team of instructional designers and content developers. This is a remote position open to candidates residing in the US except Alaska, Austin Metro, Boulder Metro, California, Chicago Metro, Connecticut, Dallas Metro, Denver Metro, Houston Metro, Maryland, Massachusetts, New Jersey, New York, Rhode Island, Seattle Metro, and Washington, D.C.