Quality Compliance Nurse and Compliance Coordinator

1 week ago


Los Angeles, California, United States Preferred IPA of California Full time
Job Description

Job Description

Openings for both a Quality Compliance Nurse and a Compliance Coordinator.

QUALITY COMPLIANCE NURSE

PURPOSE:


The Quality and Compliance Nurse is responsible for working with the Medical Director, the VP of Clinical Policy, the QM Committee in developing, implementing, and refining the Quality Management Program.

They are also responsible for oversight and management of Health Plan Audits, as well as responding to Appeals and Grievances.


ESSENTIAL DUTIES:
Organizes and participates in QM Committee meetings. Prepares agenda and meeting minutes. Provides support functions necessary for effective QM Committee processes.

Helps in the development and maintenance of the QM Plan, annual work plan and quarterly reports in conjunction with the QM Committee.

In collaboration with VP of Clinical Policy and Client Health Services Department, identifies quality standards and clinical benchmarks.

As part of quarterly reporting, establishes QM processes through tracking and trending of data for identification of under and over utilization.

Coordinates QM functions between Medical Management Department, Physician Group, Health Plan and outpatient care settings assuring quality improvement in clinical care and non-clinical aspects of service.

Provides oversight and management of Health Plan audits including the preparation of all needed documents
Timely review and processing of appeals and UM department grievances according to Medical Management policies and procedures.
Develops and monitors compliance with responses to corrective action plans (CAP) for post health plan audits and regulatory audits.
Acts as liaison to all affiliated health plans.

COMPLIANCE COORDINATOR
The Compliance Coordinator is responsible for supporting the Quality Compliance Nurses for audit preparation. This includes review of audit tool, requesting authorization universes and file preparation for audit submission.


Company Description Thrifty Management Services is the dedicated MSO for Preferred IPA of California, providing the best possible care management, care coordination, and claims processing services to Preferred IPA and their members.

We work with the network's participating physicians to coordinate patient care when a referral is made to a specialist or hospital for diagnosis and treatment.

We coordinate patient care across all aspects of the provider network. We provide high quality services to its participating physicians and superior health care to its members.

Company Description


Thrifty Management Services is the dedicated MSO for Preferred IPA of California, providing the best possible care management, care coordination, and claims processing services to Preferred IPA and their members.

We work with the network's participating physicians to coordinate patient care when a referral is made to a specialist or hospital for diagnosis and treatment.

We coordinate patient care across all aspects of the provider network. We provide high quality services to its participating physicians and superior health care to its members.
#J-18808-Ljbffr

  • Los Angeles, California, United States Conselium Compliance Search Full time

    We are representing a large global organization in their search for a Compliance Contracts Manager to work on a hybrid basis in the Greater Los Angeles CA area. If you are considering sending an application, make sure to hit the apply button below after reading through the entire description. Why Join Us: Fast growing and stable organization with ongoing...


  • Los Angeles, California, United States Core MedStaff Full time

    Job Description Job Description The Company:Core MedStaff is a leading provider of per diem and travel nurse professionals in the greater Los Angeles area. We distinguish ourselves through our commitment to quality and integrity in our business practices, our unique appreciation for the contributions made by our team members and the one-on-one relationships...


  • Los Angeles, California, United States USC Full time

    The RSO Compliance Coordinator is part of the Campus Activities team and reports to the Assistant Director of Campus Activities, Campus Activities plays a key leader within USC Student Life and the University. The Campus Activities department has a significant impact on the student experience for a campus of 49,500 students and is responsible for the...


  • Los Angeles, California, United States KHEIR Full time

    Job Description Job Description Compliance CoordinatorFull-Time, Non-exempt Position Our community clinic is seeking a passionate and detail-oriented individual to join our team as a Compliance Coordinator. The Compliance Coordinator will be responsible for ensuring the clinic's compliance with all relevant laws, regulations, and policies. This position will...


  • Los Angeles, California, United States Alo Yoga Full time

    WHY JOIN ALO?Mindful movement. It's at the core of why we do what we do at Alo—it's our calling. Because mindful movement in the studio leads to better living. It changes who yogis are off the mat, making their lives and their communities better. That's the real meaning of studio-to-street: taking the consciousness from practice on the mat and putting it...


  • Los Angeles, California, United States Alo Yoga Full time

    WHY JOIN ALO?Mindful movement. It's at the core of why we do what we do at Alo—it's our calling. Because mindful movement in the studio leads to better living. It changes who yogis are off the mat, making their lives and their communities better. That's the real meaning of studio-to-street: taking the consciousness from practice on the mat and putting it...

  • Compliance Advisor II

    4 weeks ago


    Los Angeles, California, United States L.A. Care Health Plan Full time

    Salary Range: $77, Min.) - $100, Mid.) - $123, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...

  • Compliance Advisor II

    1 month ago


    Los Angeles, California, United States L.A. Care Health Plan Full time

    Salary Range: $77, Min.) - $100, Mid.) - $123, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...

  • Compliance Officer

    2 months ago


    Los Angeles, California, United States Xsolla Full time

    We are seeking a meticulous and detail-oriented Compliance Officer to ensure that our products maintain all necessary operating licenses and adheres to all relevant laws, regulations, and industry standards. The Compliance Officer will play a critical role in identifying potential compliance risks related to licensing requirements, implementing policies and...

  • Compliance Officer

    4 weeks ago


    Los Angeles, California, United States Xsolla Full time

    We are seeking a meticulous and detail-oriented Compliance Officer to ensure that our products maintain all necessary operating licenses and adheres to all relevant laws, regulations, and industry standards. The Compliance Officer will play a critical role in identifying potential compliance risks related to licensing requirements, implementing policies and...

  • Compliance Director

    1 week ago


    Los Angeles, California, United States Alura Workforce Solutions Full time

    Position Compliance Director On-Site Position, Los Angeles Affordable/Permanent Supportive Housing Experience Required *In the face of the escalating homelessness crisis in Los Angeles, where the need for assistance is more pressing than ever, are you dedicated to making a positive impact in the lives of those affected? Join the team at the largest permanent...


  • Los Angeles, California, United States Larson Maddox Full time

    Larson Maddox is partnered with a private investment firm looking for a Legal & Compliance Analust to report to the General Counsel / Chief Compliance Officer (GC/CCO).Essential Duties and Responsibilities:Maintain and organize internal compliance books and records.Retain distribution records of client documents evidencing reviews and approvals.Coordinate...


  • Los Angeles, California, United States Spencer Ogden Full time

    Most of the company's facilities are located in California. Under the direction of the Environmental Compliance Supervisor, this position will primarily engage in providing environmental compliance support to the EHS, construction and operations teams during the late-stage development and construction phase of renewable assets portfolio in California and...


  • Los Angeles, California, United States Spencer Ogden Full time

    Most of the company's facilities are located in California. Under the direction of the Environmental Compliance Supervisor, this position will primarily engage in providing environmental compliance support to the EHS, construction and operations teams during the late-stage development and construction phase of renewable assets portfolio in California and...


  • Los Angeles, California, United States UCLA Full time

    The Compliance Specialist provides support and assistance to the Chief Compliance and Audit Officer with administering the University Compliance Program. Manages key compliance-related projects that include working directly with stakeholders to develop project deliverables, tracking the progress of deliverables, and reporting project statuses to campus...


  • Los Angeles, California, United States L.A. Care Health Plan Full time

    Salary Range: $60, Min.) - $0.00 (Mid.) - (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure...


  • Los Angeles, California, United States L.A. Care Health Plan Full time

    Salary Range: $60, Min.) - $0.00 (Mid.) - (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure...


  • Los Angeles, California, United States L.A. Care Health Plan Full time

    Salary Range: $60, Min.) - $0.00 (Mid.) - (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure...


  • Los Angeles, California, United States Childrens Hospital Los Angeles Full time

    NATIONAL LEADERS IN PEDIATRIC CARERanked among the top 10 pediatric hospitals in the nation, Children's Hospital Los Angeles (CHLA) provides the best care for kids in California.Here world-class experts in medicine, education and research work together to deliver family-centered care half a million times each year. From primary to complex critical care, more...


  • Los Angeles, California, United States Career Strategies Inc. Full time

    Job DescriptionJob DescriptionAre you passionate about making a positive impact on your community? We're on the lookout for adedicated Compliance Specialist with expertise in low-income housing tax credits to join our non-profitorganization located in Downtown Los Angeles. Our non-profit's core mission is to provide housing andbreak the cycle of...