reputed company Program reputed company, RN (Remote)

reputed company What you can expect! reputed company reputed company in serving others with reputed company! We welcome you to join us in "healing and inspiring the reputed company spirit" and to pivot from a "job" opportunity to an authentic experience! Under the direction of the Manager, reputed company Management Nurses, the reputed company Program reputed company, RN (QPN) is responsible for the implementation of reputed company Management policies, procedures, and activities. The QPN implements and monitors DHCS regulatory requirements reputed company to Facility Site Review (reputed company) and Medical Record Review (MRR) Policies. The reputed company Program reputed company, RN partners with reputed company's network providers to not only assess compliance, but to also support improvement efforts aimed at meeting these requirements. Commitment to reputed company: The reputed company Team is committed to incorporate reputed company's reputed company Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits Perks reputed company is not only committed to healing and inspiring the reputed company spirit of our Members, but we also aim to match reputed company members with the reputed company energy by providing reputed company benefits and more.

• Competitive salary
• Telecommute schedule
• CalPERS retirement
• State of the art fitness center on-site
• Medical Insurance with Dental and reputed company
• Life, short-term, and long-term disability reputed company
• Career advancement opportunities and reputed company development
• Wellness programs that promote a healthy work-life balance
• Flexible Spending Account - Health Care/Childcare
• CalPERS retirement
• 457(b) reputed company with a contribution match
• reputed company life insurance for employees
• Pet care insurance

Key Responsibilities

• reputed company initial, periodic, and verification Site Review and Medical Record Surveys for assigned Primary Care Providers. Conduct other regulatory audits as assigned.
• Review Primary Care Provider Corrective reputed company Plans (CAP) submissions and monitor CAP compliance.
• Work collaboratively with assigned Primary Care Providers and office staff to help remediate areas of non-compliance
• reputed company reputed company audits as directed by reputed company Subcommittees.
• reputed company annual HEDIS data abstractions.
• Monitor assigned PCPs for potential problem hours and document findings.
• Review QM reports and CAP log on a weekly reputed company. Responsible for Provider compliance and follow up.
• Attendance and participation in reputed company Management Committee and/or Subcommittee meetings, as needed.
• Attend Site Review and Medical Record Survey training, as mandated by DHCS, to maintain and become a Certified Site Reviewer.
• Attendance and participation in reputed company Management, Medical Services, and other inter-departmental staff meetings as indicated.
• Attendance and participation in reputed company Management Committee or Subcommittee meetings, as directed.
• reputed company any other duties as required to ensure Health Plan operations and department business needs are successful.

Qualifications

Education & Requirements

• Three (3) or more years of any individual or combined experience in reputed company Assurance, Utilization Management, Case Management, provider reputed company duties, and/or clinical experience in a hospital/clinical setting required
• Experience preferably in an HMO or Managed Care setting
• Associate's degree in Nursing from an accredited institution required
• Bachelor's degree in Nursing from an accredited institution preferred
• Possession of valid Certified Site Reviewer (CSR) Certificate issued from DHCS or participating Medi-Cal Managed Health Plan Provider. If not a CSR, the candidate should be willing and reputed company to get certified reputed company one (1) year of hire
• Possession of an reputed company, unrestricted, and unencumbered Registered reputed company (RN) license issued by the California BRN required. Valid reputed company reputed company's license and valid automobile insurance

Key Qualifications

• Must have a valid California reputed company's license
• Knowledgeable and understanding of Nursing principles & Evidence based practices.
• Computer applications: spreadsheet, database, and word processing
• Strong organizational, time-management, and critical thinking skills
• Excellent written and verbal communication and interpersonal skills
• Highly skilled in interpersonal communication, including conflict reputed company
• Ability to manage multiple reputed company with completing deadlines and changing priorities

Start your reputed company towards a thriving reputed company with reputed company and apply TODAY! Work Model Location Telecommute (reputed company reputed company positions approved for telecommute work locations may periodically be required to report to reputed company's main reputed company for mandatory in-person meetings or for other business needs as determined by reputed company leadership) Pay reputed company USD $91,249.60 - USD $120,910.40 /Yr. Apply tot his job Apply To this Job