Utilization Management Nurse RN Temporary Central California Alliance for HealthUtilization Management Nurse RN TemporaryCARemote$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).
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).
Bilingual Spanish Telephonic RN Nurse Case Manager -Special Needs Plan (California RN Required) (Remote) Alignment Healthcare IncBilingual Spanish Telephonic RN Nurse Case Manager -Special Needs Plan (California RN Required) (Remote)CARemote$77,905–$116,858 / yearThis is a fully remote, phone-based position where you''ll play a vital role in helping members navigate their care journeys, close gaps in care, and overcome barriers to better health. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
RN Clinical Consultant Titanium Healthcare IncRN Clinical ConsultantCARemoteAssociate's degree in nursing Minimum 1+ years of experience as an RN working in a healthcare setting, such as a medical clinic or acute care hospital A current and unrestricted CA state RN license Experience using an EHR Distraction-free home workspace with a secure internet connection. POSITION SUMMARY The RN Clinical Consultant is a key member of Titanium Healthcare's Enhanced Care Management (ECM) program, providing clinical oversight and guidance to support high-quality, coordinated care for complex member populations.
Grievance & Appeals Nurse, RN (Remote) Inland Empire Health PlanGrievance & Appeals Nurse, RN (Remote)California, CARemoteReporting to the Supervisor, Grievance & Appeals, the Grievance & Appeals Nurse, RN (G&A Nurse, RN) is responsible for working directly with the IPAs, Hospitals, internal IEHP departments, and the Grievance team to ensure Grievance and Appeal cases are processed per the Grievance Policy & Procedures and Department of Managed Health Care (DMHC)/ Department of Health Care Services (DHCS)/ Center for Medicare and Medicaid Services (CMS) regulations and NCQA. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell.
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.
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.
Quality Program Nurse, RN (Remote with field work) Inland Empire Health PlanQuality Program Nurse, RN (Remote with field work)California, CARemoteThree (3) or more years of any individual or combined experience in Quality Assurance, Utilization Management, Case Management, provider liaison duties, and/or clinical experience in a hospital/clinical setting. Under the direction of the Manager, Quality Management Nurses, Quality Program Nurses (QPN) are responsible for the implementation of Quality Management policies, procedures, and activities.
NewDirector of Sales & Business Development Harris Computer SystemsDirector of Sales & Business DevelopmentCARemote$80,000–$110,000 / yearYou'll work alongside experienced professionals, including a professional services team comprised of Registered Nurses and former perioperative staff, who bring deep clinical expertise and a customer-centric perspective to every challenge. About Picis: Join Picis, a global leader in perioperative and critical-care information systems, where you'll be part of a team that is genuinely pleased with their colleagues and thrives in a positive, comfortably fast-paced environment.
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.
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 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.
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.
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.
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.