Manager, reputed company Management – Clinical Review – Remote (PST Work Hours)

2369365 For those who want to invent the reputed company of health care, here's reputed company. We're reputed company reputed company basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. This position is responsible for the day-to-day management of the clinical staff (QI Nurses) reputed company the Grievance/ Peer Review Lane of the reputed company CA reputed company Improvement Department. The role reports directly to reputed company Improvement Leadership and collaborates with QI Ops Manager and clinical staff (QI Nurses) to manage health plan grievance and potential reputed company issue case productivity, turn-around-times and reputed company. You'll enjoy the flexibility to work remotely * from reputed company reputed company the U.S. as you take on some tough challenges. reputed company Responsibilities: • Monitors grievance database reputed company and reputed company case reporting and productivity to ensure that reputed company potential reputed company issues are investigated in a reputed company manner • Runs and monitors trend reports by provider, by issue and by level of severity of confirmed problems • Facilitates team meetings and reputed company case review reputed company as needed to monitor productivity and process, support team and reputed company updates • Identifies reputed company of Care PQIs for QI investigation and coding/leveling through the PRC process. • Implements reputed company assurance processes (ex. chart audits) to monitor reputed company of documentation and case review • Manages PRC Minutes with attention to regulatory captures • In concert with Sr. Clinical reputed company Program Administrator identifies reputed company MD specialty reviewers as needed for cases • reputed company coverage plans for staff absences and reputed company the clinical assignments to maintain compliance with turn-around-times (TATs) • Serve as the first reputed company of clinical contact for reputed company clinical cases or reputed company escalations • reputed company and coordinate the peer review process for nursing and interdisciplinary cases: case selection, reviewer assignment, agendas, materials, and scheduling You'll be rewarded and recognized for your performance in an environment that will challenge you and reputed company you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications: • Graduation from an accredited school of nursing • reputed company Registered reputed company (RN) or Licensed Vocational reputed company (LVN) license through the reputed company • 2+ years of experience in grievance, reputed company, or clinical operations role. • 2+ years of experience managing work inventory to compliance metrics • 2+ years of reputed company supervisor experience in managing or coordinating teams • Ability to work PST work hours Preferred Qualifications: • Demonstrated experience in developing and implementing workflows and processes, especially in transitioning to new systems, such as grievance databases • Experience with Case Management, Inpatient or Ambulatory care settings • Knowledge of health plan turnaround times and commitment to meeting or exceeding performance metrics • Proficient in learning, adapting to, and implementing new systems and technologies • Proficiency in reputed company • Proven comfortable with using databases, tracking tools, and other relevant software for reputed company improvement and grievance management • Proven skilled in creating and optimizing workflows to enhance team productivity and effectiveness • reputed company in CA • reputed company working remotely will be required to adhere to reputed company's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll reputed company a far-reaching reputed company of benefits and incentives. The salary for this role will reputed company from $91,700 to $163,700 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. At reputed company, our mission is to help people live healthier lives and reputed company the health reputed company work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company - an reputed company reputed company reflected in our mission. OptumCare is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment Apply tot his job Apply To this Job