HEDIS Pharmacy Outreach Coordinator

Job DescriptionPosition Summary: The HEDIS Pharmacy Outreach Coordinator is an active member of the HEDIS department and works closely with other team members and management. The HEDIS Pharmacy Outreach Coordinator will perform outbound calls to beneficiaries regarding quality measures related to medications. The HEDIS Pharmacy Outreach Coordinator will...

Job DescriptionPosition Summary:The HEDIS Pharmacy Technician is an active member of the HEDIS department and works closely with other team members and management. The HEDIS Pharmacy Technician will assist with quality measures related to medications and disease states including diabetes and dyslipidemia. The HEDIS Pharmacy Technician will report to the...

Job DescriptionPosition Summary:Responsibilities include but are not limited to data entry, maintenance, and reporting in, of and from the Contract Database (CDB); verification and processing of various forms used by, Network Management, HR, Corporate and IS; and gathering provider information from a variety of sources.Essential Duties and Responsibilities...

Job DescriptionThe Medical Director of Risk Adjustment is responsible and accountable for the performance of a specific region in terms of RAF score for all product lines that risk adjust and quality scores for all product lines. The Medical Director will be working with internal staff, larger and exclusive PCPs, and CFO to ensure performance of the assigned...

Job DescriptionAfter Hours work schedule: Fully remote, 3 weeknights from 5 pm - 9 pm; 12 hour shift every weekend from 8 am - 9 pm, and 12 hour shift every holiday from 8 am - 9 pm.We are looking for Inpatient Coordinators to join our team in Northridge after hours team to help support our members in the San Fernando /Simi Valley areas.Position Summary:The...

Job DescriptionPosition Summary: Credential all new providers, Re-credential existing Providers according to Regal Medical Group credentialing policies and procedures. Submit credentialing information as requested by contracted HMOs. Maintain and update files on all credentialed Providers. Provide credentialing information on a Provider when requested by...

Job DescriptionPosition Summary:The Inpatient Coordinator is responsible for supporting the process that manages all hospital and skilled nursing admissions, concurrent review, and discharge planning. The goal of the Inpatient Care Coordinator is to effectively support the in-patient management process by assuring the right information is provided timely to...

Job DescriptionPosition Summary: The Inpatient Coordinator is responsible for supporting the process that manages all hospital and skilled nursing admissions, concurrent review, and discharge planning. The goal of the Inpatient Care Coordinator is to effectively support the in-patient management process by assuring the right information is provided timely to...

Position Summary:This individual will be accountable for providing clinical care management and coordination support to high-risk members with cardiovascular related diagnosis/conditions in the Northwest Region of Regal Medical Group (Regal). This position is embedded in a cardiology clinic and supports members enrolled in Regal cardiovascular disease...

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork,...

Job DescriptionEssential Duties Responsibilities include the following :Works collaboratively with campus medical directors, managers and staff working in concurrent review/Vital Care management/Prior Authorization Departments. Monitors and analyzes UM protocols and identifies trends and makes recommendations and develops programs and interventions to...

**Essential Duties and Responsibilities include the following**: - Schedule interviews for hiring managers in multiple locations. - Assist in managing 40-150 openings at any given time. - Manage full cycle recruitment for assigned requisitions. - Pre-screen, forward and follow-up on resume submittals to Hiring Managers. - Track and facilitate testing and...

We are seeking to hire an IP Nurse to join our team! We are a skilled nursing facility looking for dynamic associates to join our clinical team and provide our residents with a best-in-class care experience! Whether you are just starting your career or have years of experience we want to meet you!The IP Nurse is responsible for the implementation of the...

The Care Coordinator is responsible for navigating the care management across the continuum of care of the member from acute to outpatient case management. The Coordinator, Care role is to incorporate administrative job functions to provide optimal care and coordination of care. The individual will assist with both the Inpatient (Acute/Skilled) and case...

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork,...

Job DescriptionPosition Summary:The Denial Nurse is responsible for being the "second line" resource for preparing and maintaining health plan criteria for the campus Medical Directors. This includes collaborating with each Health Plan to obtain updated/adequate criteria for each specialty to ensure that appropriate criteria are referenced upon furnishing a...

Job DescriptionPosition Summary: The Behavioral Health Case Manager RN collaborates with an inter-disciplinary care team to provide patient-centered case management and support to members with primary need for behavioral health services. Promotes and ensures ongoing engagement in behavioral health services. Helps to mitigate psychosocial and behavioral...

Job DescriptionThis site works a 4/10 Alternative Work ScheduleAssists the PACU Charge Nurse in the daily clinical operations of the PACU in accordance with established Federal, State, and accreditation standards and center policies and procedures. Participates in direct patient care including maintaining a clean, orderly and safe environment.The...

We are a skilled nursing facility looking for dynamic associates to join our clinical team and provide our residents with a best-in-class care experience! The IP Nurse is responsible for the implementation of the Infection Control program of the facility including antibiotic stewardship program. Employee will also be responsible in keeping facility staff and...

The role of the Denial Nurse is to promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to denials. The Denial Nurse LVN will review for appropriate care and setting and following guidelines/policies as it relates to denials. The Denial Nurse LVN is responsible for...