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.
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 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.