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.
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.
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.
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.
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.
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.
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.
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.