Clinical Audit Specialist

**Overview of Blue Shield of CaliforniaWe are a not-for-profit health plan that provides high-quality healthcare services to millions of Californians. Our mission is to make a meaningful difference in the lives of our members by delivering innovative, patient-centered care.About the RoleWe are seeking an experienced Clinical Review Specialist - Utilization...

Job Title: Clinical Nurse SpecialistFifth Commandment Healthcare Staffing, LLC is seeking a highly skilled Clinical Nurse Specialist to join our team. This role requires 2 years of acute care experience, with a focus on Cardiac Telemetry.Salary:$80,000 - $120,000 per yearJob Description:We are looking for a dedicated and compassionate nurse to work in a...

Job Title: Human Resources Generalist - Onboarding and Compliance Specialist About The Children's ClinicThe Children's Clinic, a mission-driven healthcare organization, is seeking a detail-oriented and highly organized Human Resources Generalist to support daily HR operations and ensure compliance across our healthcare facilities. As a member of our HR...

Job Title: PICU Clinical Nurse SpecialistJob Summary:Fifth Commandment Healthcare Staffing, LLC is seeking an experienced PICU Clinical Nurse Specialist to join our team. As a PICU Clinical Nurse Specialist, you will be responsible for providing high-quality patient care and leading the nursing team in the Pediatric Intensive Care Unit.Key Responsibilities:-...

About the Position:Molina Healthcare is seeking a highly skilled Clinical Review Nurse to join our team as a SIU Investigator. As a Clinical Review Nurse, you will be responsible for reviewing and analyzing information to make medical determinations and applying clinical knowledge to assess the medical necessity of services.Responsibilities:Review and...

Job SummaryWe are seeking a skilled Clinical Support Specialist to join our team at Pacific Neuropsychiatric Specialists Inc.About the RoleThis is a full-time position that offers a competitive compensation package including medical, dental, and vision insurance, paid time off, and hourly rate based on skill, experience, and tenure.Key...

Clinical Specialist Opportunity We are seeking a skilled Clinical Specialist to join our team in the GI Lab at TotalMed. This is an exciting opportunity for experienced nurses to work with our esteemed clients and contribute to providing exceptional patient care. As a valued member of our team, you will be responsible for delivering high-quality nursing...

About TotalMed StaffingTotalMed is a leading healthcare staffing agency with a mission to provide top-notch clinical professionals to facilities nationwide.We are dedicated to igniting purpose in healthcare by matching skilled caregivers with the right organizations to ensure exceptional patient outcomes.Job OverviewTotalMed is seeking an experienced...

Compliance Specialist - Affordable HousingAbout Us:Avanath is a leading provider of affordable housing solutions, dedicated to making a positive impact on the lives of hardworking American families.Job Summary:We are seeking a highly skilled and detail-oriented Compliance Specialist to join our team. As a Compliance Specialist, you will be responsible for...

Job SummaryThe Clinical Review Specialist, Senior at Blue Shield of California will lead retrospective utilization reviews and first-level determination approvals for members using BSC evidenced-based guidelines, policies, and nationally recognized clinical criteria across lines of business or for a specific line of business such as Medicare and FEP.Key...

Job SummaryThe Provider Contract Recruiter (Network/Sales) role is a critical member of the network development team at Dental Health Services. This position assumes overall responsibility for successfully managing relationships with dental organizations as accounts, ensuring access to care requirements are met and supporting the growth of strong, stable...

OverviewIncredible Health is actively seeking a skilled Registered Nurse to fill the position of Clinical Nurse Specialist - Infusion Leadership in Long Beach, CA.Job Summary:This role entails providing guidance and support to infusion teams, promoting best practices and ensuring exceptional patient care. The ideal candidate will possess experience in...

Job SummaryThe Clinical Support Specialist will perform all support functions in the Radiology department, including transporting patients, clerical duties, and reception work. This role requires strong communication skills to interact effectively with others and demonstrate problem-solving ability.About MemorialCareMemorialCare is a nonprofit integrated...

Job SummaryWe are seeking a Senior Clinical Coordination Specialist to oversee patient care coordination in outpatient settings and promote health and wellness.About the Role:Develop individualized care plans to ensure appropriate management of patient needs.Collaborate with healthcare professionals to coordinate patient care and services.Conduct health...

Job SummaryPursue a rewarding career as a Payroll Operations Specialist with the Retirement Housing Foundation, where you will play a vital role in ensuring seamless payroll processing for our multi-state facilities. As a key member of our team, you will be responsible for managing complex payroll operations, maintaining accurate records, and providing...

Job SummaryWe are seeking a highly experienced Clinical Diabetes Specialist to join our team at Sequel Medical Technology. In this role, you will be responsible for delivering exceptional clinical education and product training to people with diabetes and healthcare providers, driving the adoption and consistent use of our innovative insulin pump...

About the RoleSodexo, a global leader in the food industry, is seeking an experienced Registered Dietitian to join their clinical team at Hoag Hospital Irvine and Hoag Newport Beach. As a Clinical Nutrition Specialist, you will play a vital role in providing nutritional care for patients across various inpatient units.Key Responsibilities:Deliver...

At Blue Shield of California, we're seeking an experienced Senior Clinical Utilization Review Nurse to join our Facility Compliance Review team. This role is ideal for a highly skilled professional who can ensure medical necessity and billing standards are met.Key Responsibilities:Conduct retrospective utilization reviews and first-level determination...

About the RoleWe are seeking a highly skilled and experienced System Configuration Lead to join our Clinical Operations team at Advanced Medical Management.Job SummaryThe successful candidate will be responsible for managing and overseeing system configuration, benefits, and provider data to ensure accurate reflection of provider contracts and claims...

Role Overview:The Clinical Coding Analyst RN Senior will be responsible for performing in-depth quality audits of hospital claims to support ICD-10-CM and ICD-10 PCS codes, as well as MS-DRG and APR-DRG reviews based on clinical determination. This role requires a strong understanding of medical necessity and reimbursement requirements, as well as the...