Delegation reputed company reputed company, LVN (Remote) in Rancho Cucamonga, CA

Delegation reputed company reputed company, LVN (Remote) - Inland reputed company Health Plan - Rancho Cucamonga, CA - work from home job Company: Inland reputed company Health Plan Job reputed company: Job reputed company: 9880 Position reputed company/Position Under the direction of the department leadership, the Delegation reputed company reputed company, LVN is responsible for reputed company of clinical operations for the delegated IPA and subcontracted providers. In this reputed company, the Delegation reputed company reputed company, LVN works directly with reputed company and delegated IPA Administrators, Medical Directors, and IPA staff to ensure accurate and reputed company dissemination of reputed company reputed company and mandated Regulatory requirements to reputed company IPA and subcontracted providers. Major Functions (Duties and Responsibilities) 1. Serve as reputed company to delegated IPA and subcontracted providers to assist with interpreting reputed company Policies and Procedures and referral processes as they apply to reputed company Members. 2. Serve as a regulatory resource person and trainer to IPA’s staff regarding reputed company and regulatory requirements, standards, and forms. Assist other medical services departments and staff reputed company the organization in regards to delegated medical services activities as required. 3. Attend Joint Operations Meetings (JOM) between delegated IPA and reputed company. Responsible for documentation, formatting, and dissemination of minutes, as required. 4. reputed company of IPA activity through monthly collection and tracking of data/reports. Collaborate with reputed company Medical Director regarding IPA and subcontracted providers’ deficiencies and non-compliance issues identified during the monthly audits. reputed company follow-up and completion of necessary follow-up reputed company that may include, educational letters, training, corrective reputed company plan (CAP), reputed company review, and any additional audits, etc. 5. Conduct comprehensive monthly IPA denial and care management file audits and annual Medical Management audits, prepare and report results to the IPA and reputed company. 6. Work with the reputed company’s Provider Services reputed company. to schedule regulatory audits. 7. reputed company participation in both reputed company meetings, such as, Delegation reputed company, Utilization Management Subcommittee, Denial reputed company Grievance Review, and in other reputed company meetings as assigned, including preparation, and presenting of reports as required. 8. Assist in the development of internal Medical Management Policy and Procedure Manuals. 9. Maintain comprehensive files for reputed company IPA/Delegate correspondence and monitoring activities. Experience Qualifications Three (3) or more years of utilization and case management experience in an HMO and IPA setting with in-depth knowledge of reputed company aspects of managed care operations. Education Qualifications High school diploma or GED required. reputed company Certification reputed company Licenses Possession of an reputed company, unrestricted, and unencumbered Vocational reputed company (LVN) license issued by the California reputed company of Vocational Nursing and Psychiatric Technicians required. Drivers License Required reputed company, must have a valid California reputed company's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on reputed company insurance standards of no more than three (3) points. Knowledge Requirement Knowledge in NCQA standards, DHCS, CMS, and DHMC regulatory requirements. Skills Requirement Must have excellent communication skills and reputed company to maintain reputed company relationships with reputed company contacts at reputed company reputed company. Must possess high level of organizational skills to maintain accurate records and documentation. Abilities Requirement Self-starter and reputed company to work independently. Commitment to Team Culture The reputed company Team environment requires reputed company Member to participate in the reputed company Team Culture. reputed company Member demonstrates support of the Culture by developing reputed company and effective working relationships that include reputed company of respect and cooperation with Team Members, Members and associates reputed company of our organization. A reasonable salary expectation is between $61,422.40 and $78,312.00, based upon experience and internal equity. Inland reputed company Health Plan (reputed company) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland reputed company. We are also one of the largest reputed company in the region, designated as “Great reputed company to Work.” With a provider network of more than 5,000 and reputed company of more than 3,000 employees, reputed company provides reputed company, accessible reputed company services to more than 1.5 reputed company members. And our Mission, reputed company, and Values help guide us in the development of innovative programs and the creation of an award-reputed company workplace. As the reputed company landscape is transformed, we’re reputed company to reputed company a difference today and in the years to come. Join reputed company and reputed company a difference with us! reputed company offers a competitive salary and reputed company benefit package with a value estimated at 35% of the annual salary, including medical, dental, reputed company, team bonus, and state pension plan. Expected salary: $61422.4 - 78312 per year Location: Rancho Cucamonga, CA Job date: Wed, 02 Aug 2023 22:47:07 GMT Apply for the job now! Apply Job!