Remote Hospice Triage RN PT 3:30p-11p Compact & CA license needed IntellaTriage, Inc.Remote Hospice Triage RN PT 3:30p-11p Compact & CA license neededCARemoteUtilizing best-in-class technology, IntellaTriage provides round-the-clock direct access to licensed, registered nurses using client-customized protocols for patient-centered, compassionate care. Built around a mission to improve the lives of nurses and patients, IntellaTriage has been providing after-hours nurse triage for hospice and home health providers since 2008.
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.
RN Case Manager (Must live in Los Angeles) SCM AssociatesRN Case Manager (Must live in Los Angeles)North Hollywood, CARemoteThe goal of the case manager is to provide for quality, cost-effective outcomes for the client through collaboration and communication with the client, the family, the physician, and other members of the health care team. Assesses the client/family to identify their strengths and resources; problems; psychosocial, financial, and medical history; current status; diagnosis; prognosis; functional status; goals; current treatment plan; and needs.
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.
RN Supervisor Cohere Health Technologies LLCRN SupervisorCARemote$85,000–$95,000 / yearBacked by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners, Cohere Health drives more transparent, streamlined healthcare processes, helping patients receive faster, more appropriate care and higher-quality outcomes. By unifying pre-service authorization data with post-service claims validation, we're creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately.
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.
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.
NewCare Manager RN (Per Diem Day) Providence Health & ServicesCare Manager RN (Per Diem Day)Torrance, CARemote$57.28–$88.92 / hourRequsition ID: 456055 Company: Providence Jobs Job Category: Care Management Job Function: Clinical Care Job Schedule: Per-Diem Job Shift: Day Career Track: Nursing Department: 7000 UTILIZATION MGMT CA SOCAL Address: CA Torrance 21311 Madrona Ave Work Location: PMI Madrona-Torrance 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.
NewCare Manager RN - Utilization Management (Full time Day) Providence Health & ServicesCare Manager RN - Utilization Management (Full time Day)Torrance, CARemote$57.28–$88.92 / hourRequsition ID: 454390 Company: Providence Jobs Job Category: Care Management Job Function: Clinical Care Job Schedule: Full time Job Shift: Day Career Track: Nursing Department: 7000 UTILIZATION MGMT CA SOCAL Address: CA Torrance 21311 Madrona Ave Work Location: PMI Madrona-Torrance 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.
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.
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.
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.
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.