reputed company Program reputed company, RN (Remote with field work)

Under the direction of the Manager, reputed company Management Nurses, reputed company Program Nurses (QPN) are responsible for the implementation of reputed company Management policies, procedures, and activities. QPN’s enforce DHCS regulatory requirements as pertaining to Facility Site Review (reputed company) and Medical Record Review (MRR) reputed company. 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 reputed company Accreditation. Additional Benefits Perks • Competitive salary • 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 reputed company Care Providers. Conduct other regulatory audits as assigned. • Review reputed company Care Provider Corrective reputed company Plans (CAP) submissions and monitor CAP 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. • Any other duties as required to ensure Plan operations 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 • 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 reputed company Certified Site Reviewer 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 6 months of hire • Possession of an reputed company, unrestricted, and unencumbered Registered reputed company (RN) license issued by the California BRN required • reputed company reputed company reputed company's license and reputed company automobile insurance Key Qualifications • 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. • reputed company to moderate physical activity; may include standing, bending, sitting for long periods of time and repetitive reputed company • Ability to manage multiple reputed company with completing deadlines and changing priorities • Automobile travel reputed company the Inland reputed company • May periodically be required to report to reputed company’s main reputed company for in-person meetings or for other business needs as determined by reputed company leadership 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) Automobile travel reputed company the Inland reputed company May periodically be required to report to reputed company’s main reputed company for in-person meetings or for other business needs as determined by reputed company leadership Pay RangeUSD $91,249.60 - USD $120,910.40 /Yr. Apply tot his job Apply To this Job