Jobs

10 results

All jobs posted within the past 30 days.

Care Management Specialist RN - FT - 833B

The Care Management Specialist is primarily responsible for the overall coordination of care and services for LA Care Health Plan members. Responsibilities include, technology implementation and integrity, ensuring regulatory and accreditation compliance, program utilization and outcome ...

Quality Management Specialist RN - FT - 545A

The Quality Management Specialist - PQI position manages the organization's clinical grievance review process including investigation of all quality reviews for potential quality of care concerns and quality of service and access issues, including collection of ...

Utilization Management Oversight Nurse Specialist - FT - 1152A

The Utilization Management Specialist Position ensures compliance of the participating physician groups (PPGs) with regulatory, contractual and LA Care requirements. The UM Specialist is responsible for performing annual and focused audits and continuous monitoring activities. This ...

RN Appeals & Grievance Nurse Specialist - FT - 886B

The Grievance & Appeals Nurse Specialist provides direct assistance to member's with health care access or benefit coordination issues, ensuring that clinical grievances, complaints and complex issues are investigated and resolved to the member's satisfaction in a ...

RN Lead Utilization Management Oversight Specialist - FT - 249C

The Utilization Management (UM) Specialist Position ensures compliance of the Plan Partners and/ or Participating Physician Groups (PPG) to regulatory, contractual and LA Care requirements. The UM Specialistis responsible for performing annual and focused audits and ...

RN Utilization Management Oversight & Compliance Specialist - FT - 250B

The Utilization Management Oversight & Compliance Specialist, RN is responsible for assuring that the UM Department is in compliance with all UM regulatory requirements and new legislation through the maintenance of required policies/procedures/workflows/ processes/audit ...

RN Facility Site Review Nurse Specialist - FT - 1207

Conducts face-to-face visits with our high-membership physicians to provide feedback, data, and education on programs and facilitates changes to improve quality of care and service to members.  Conducts various types of site reviews of PCP and ...

Lead Care Management Specialist RN - FT - 567C

The Care Management Specialist, Lead position functions as the lead of all staff in the Medical Management Unit and is responsible for daily operational activities, including staffing, productivity and work quality. Works with the Manager and ...

RN Care Management Specialist - FT - 2088A

The Care Management Specialist is primarily responsible for the overall coordination of care and services for LA Care Health Plan members. Responsibilities include, technology implementation and integrity, ensuring regulatory and accreditation compliance, program utilization and outcome ...

RN Care Management Supervisor - FT - 2096A

The CM Supervisor is responsible for monitoring the CM clinical and non-clinical staff daily work and activities including but not limited to ensuring proper staffing and coverage, and assist in monitoring and evaluating departmental operations to ...