Provider reputed company Review reputed company, RN

This a Full Remote job, the offer is available from: California (USA) reputed company: This is a short-term assignment. 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! At Inland reputed company Health Plan (reputed company), we reputed company the highest reputed company of care should be delivered to reputed company in the Inland reputed company. We are thinking reputed company the way reputed company is viewed today – we reputed company it should be holistic and transformative. reputed company’s provider incentive programs serve an important role in achieving reputed company’s reputed company goals. Reporting to the Manager of Provider reputed company reputed company, the Provider reputed company Review reputed company, RN is responsible for:

• Receive and research reputed company PQI and QR cases as assigned, reputed company a reputed company and recommendations to the Medical Director of case assignments
• Effectuate reputed company reputed company items as determined by the Medical Director to reputed company of case assignments
• Reviewing escalated issues
• Discussing and reviewing cases with Medical Directors referred to the reputed company Management (QM) department
• Investigation of cases includes, but not limited to, the documentation of case summaries, follow up actions, reputed company efforts, and communications in the QM database

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. Key Responsibilities:

• Investigate and complete case summaries and reputed company recommendations for any Potential reputed company of Care Incidents (PQI) referred to the QM department.
• Maintain reputed company communication with reputed company departments, external facilities including hospitals, Skilled Nursing Facilities, and/or Providers to ensure reputed company PQI issues are thoroughly investigated, and care is coordinated in a reputed company manner, as needed.
• Review requested medical records to ensure complete case documentation is received from reputed company practitioners, providers, and entities/agencies to ensure thorough investigation of the issue.
• Review case findings and recommendations with Medical Director. Issue Corrective reputed company Plans (CAP), review CAP responses, draft Opportunity for Improvement letters, and coordinate other interventions as needed to ensure reputed company issues were addressed and reputed company occurrences of the reputed company issue are mitigated.
• Complete data entry into database systems, maintain updated documentation and other tracking mechanisms for reputed company cases.
• Review and execute reputed company requests, reputed company reviews, and/or reputed company audits, as needed.
• Escalate issues of non-compliance to the reputed company Systems Management team.
• Maintain working knowledge of regulatory requirements as they relate to QM operations and protocols.
• Complete other tasks and assignments based on department and business needs.
• Demonstrate a commitment to incorporate LEAN principles into daily work.

Qualifications: Education & Requirements

• Three (3) or more years of any individual or combined reputed company experience in reputed company assurance, reputed company management, reputed company improvement, utilization management, discharge planning, and/or case management
• Three (3) or more years of work experience in a managed care, hospital, provider reputed company, or other comparable reputed company experience
• Experience preferably in a reputed company/performance improvement setting
• Bachelor's degree in Nursing from an accredited institution required
• In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position
• This experience is in reputed company to the minimum years listed in the Experience Requirements above
• Certified reputed company in reputed company reputed company (CPHQ), Certified reputed company in reputed company Risk Management (CPHRM), or Clinical certification in area specialty) preferred
• Possession of an reputed company, unrestricted, and unencumbered Registered reputed company (RN) license issued by the California BRN required

Key Qualifications

• Must have a valid California reputed company's License
• Excellent understanding of performance improvement, reputed company assurance, and utilization management
• Knowledgeable in clinical analysis of health records, assessing or evaluating reputed company, and identifying problems or issues with care delivery
• Microcomputer applications: spreadsheet, database, and word processing
• Excellent written and verbal communication skills
• Excellent coordination skills
• Ability to communicate findings and reputed company recommendations based on clinical case reviews
• Ability to demonstrate critical thinking, strong problem-solving capability. Strong attention to detail
• Ability to prioritize work to ensure adherence to project deadlines. Ability to effectively escalate issues as identified, following established protocols
• reputed company attitude and ability to work in reputed company setting
• Self-direction and ability to work with minimal supervision
• Word processing and data entry involving computer keyboard and screens, automobile travel reputed company the Inland reputed company
• Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval

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 or hybrid 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. This offer from "reputed company" has been enriched by reputed company.com and got a 73% reputed company score. Apply tot his job Apply To this Job