Registered Nurse
3 days ago
Are you an experienced Registered Nurse - Senior with a desire to excel? If so, then Talent Software Services may have the job for you Our client is seeking an experienced Registered Nurse - Senior to work at their company in CA that can be worked 100% remotely.
Primary Responsibilities/Accountabilities
Ensures proper procedure and diagnosis codes are reviewed for submitted procedures/claims.Solicits support from SME's, leads, and managers as appropriateTriages and prioritizes cases to meet required Turn-around timesExpedites access to appropriate care for members with urgent needsPrepares and submits clinical review cases to Medical Director (MD) for medical director oversight and necessity determinationCommunicate determinations to providers and/or members to in compliance with state, federal, and accreditation requirementsDevelops and reviews member-centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standardsIdentifies potential quality of care issues, service or treatment delays and intervenes or as clinically appropriateProvides referrals to Case Management, Disease Management, Appeals and Grievance and Quality Departments as necessaryAssists in the development and implementation of a proactive approach to improve and standardize overall retro claims review for clinical perspectives.May require weekend and holiday work and other duties as assignedQualifications:Nursing- 5 years minimumProficient in Microsoft, outlook, and excelRN License requiredCurrent CA RNRequires practical knowledge of job areas typically obtained through advanced education combined with experience.Typically, requires a college degree or equivalent experience and 5 years of prior relevant experience.Knowledge of CPT-4, ICD-10, HCPCs, and provider billing practicesKnowledge of Medicare, Medi-Cal, and CMC Regulations and mandates.Demonstrate the ability to act independently using sound clinical judgmentPreferred:Utilization ManagementLong-term careLTSSExperienced in working at Skilled Nursing Facility, Long Term Care Custodial Care, and Intermediate Care Facility for Developmental Disability, highly preferredExperience in a fast-paced, production and quality environment preferredDemonstrated efficient, time management techniques and skillsAble to handle multiple tasks simultaneously while prioritizing cases to meet regulatory and business-based turnaround timeAssociated topics: asn, ccu, intensive, intensive care unit, maternal, neonatal, nurse rn, psychatric, psychiatric, recovery
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Livermore, California, United States Maxim Healthcare Services Full timeMaxim Healthcare Services is seeking a Registered Nurse (RN) to assume responsibility and accountability for the application of the nursing process and the delivery of patient care. The Registered Nurse (RN) demonstrates the ability to make clinical judgments in an effective and efficient manner under the direction of the Director of Clinical Services. ...
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Livermore, California, United States Maxim Healthcare Services Full timeMaxim Healthcare Services is seeking a Registered Nurse (RN) to assume responsibility and accountability for the application of the nursing process and the delivery of patient care. The Registered Nurse (RN) demonstrates the ability to make clinical judgments in an effective and efficient manner under the direction of the Director of Clinical Services. ...
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Livermore, California, United States Maxim Healthcare Services Full timeMaxim Healthcare Services is seeking a Registered Nurse (RN) to assume responsibility and accountability for the application of the nursing process and the delivery of patient care. The Registered Nurse (RN) demonstrates the ability to make clinical judgments in an effective and efficient manner under the direction of the Director of Clinical...
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Livermore, California, United States Maxim Healthcare Services Full timeMaxim Healthcare Services is seeking a Registered Nurse (RN) to assume responsibility and accountability for the application of the nursing process and the delivery of patient care. The Registered Nurse (RN) demonstrates the ability to make clinical judgments in an effective and efficient manner under the direction of the Director of Clinical...
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Nurse Practitioner/Physician Assistant
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Livermore, United States Talent Software Services Full timeAre you an experienced Registered Nurse - Senior with a desire to excel? If so, then Talent Software Services may have the job for you! Our client is seeking an experienced Registered Nurse - Senior to work at their company in CA that can be worked 100% remotely.Primary Responsibilities/AccountabilitiesEnsures proper procedure and diagnosis codes are...
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Wellness Nurse
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Livermore, United States California Department of Public Health Full timeFinal Filing Date: 6/30/2024 - **Incumbents appointed to this classification shall receive the maximum of the pay range, as well as a recruitment and retention pay differential of $200/month.**_ **Please note**: All qualified applicants must possess a valid Registered Nursing (RN) license as required by the Minimum Qualifications of the HFEN classification....
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Certified Nursing Assistant
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PRN - RN - Livermore
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RN Homecare Opportunities Livermore, KY 10hr Overnights
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Livermore, United States Maxim Healthcare Service Full timeMaxim Healthcare Services is seeking a Registered Nurse (RN) to assume responsibility and accountability for the application of the nursing process and the delivery of patient care. The Registered Nurse (RN) demonstrates the ability to make clinical judgments in an effective and efficient manner under the direction of the Director of Clinical Services. ...