Clinical Quality Auditor

Position OverviewThe Clinical Access Program's Facility Site Review team is dedicated to ensuring that all MediCal members receive access to safe and high-quality healthcare providers. The Clinical Nurse Auditor, Consultant will report directly to the Clinical Training and Auditing Manager. In this capacity, you will evaluate physical site locations to...

Position OverviewThe Clinical Access Program's Facility Site Review team is dedicated to ensuring that all MediCal members receive care from safe and high-quality providers. The Clinical Nurse Auditor, Consultant will report directly to the Clinical Training and Auditing Manager. In this capacity, you will assess physical site locations to confirm adequate...

Position OverviewThe Clinical Access Program's Facility Site Review team is dedicated to ensuring that all MediCal members receive access to safe and high-quality healthcare providers. The Clinical Nurse Auditor, Consultant will report directly to the Clinical Training and Auditing Manager. In this capacity, you will evaluate physical site locations to...

About the RoleWe are seeking a highly skilled Clinical Nurse Auditor Consultant to join our team at Blue Shield of California. As a key member of our Clinical Access Program's Facility Site Review team, you will play a critical role in ensuring that all MediCal members have access to safe, high-quality providers.Key ResponsibilitiesConduct thorough clinical...

About the RoleWe are seeking a highly skilled Clinical Nurse Auditor Consultant to join our team at Blue Shield of California. As a key member of our Clinical Access Program's Facility Site Review team, you will play a critical role in ensuring that all MediCal members have access to safe, high-quality providers.Key ResponsibilitiesConduct thorough clinical...

Job OverviewWe are looking for skilled professionals in Quality Assurance to fill roles such as Inspectors, Auditors, or Process Specialists. Your primary responsibility will be to conduct assessments to ensure the quality of materials and finished goods, while also pinpointing areas for enhancement to boost operational efficiency.Key...

Job OverviewEssential Knowledge, Skills, and Abilities Conducts monthly evaluations of registered nursing and various clinical operations within Utilization Management (UM), Case Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Disease Management (DM). Monitors key clinical personnel to ensure adherence to NCQA, CMS, State, and...

Job OverviewEssential Knowledge, Skills, and Abilities Conducts monthly evaluations of registered nursing and various clinical operations within Utilization Management (UM), Case Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Disease Management (DM). Oversees key clinical personnel to ensure adherence to NCQA, CMS, State, and...

Job OverviewEssential Knowledge, Skills, and Abilities Conducts monthly evaluations of registered nursing and various clinical operations within Utilization Management (UM), Case Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Disease Management (DM). Ensures adherence of key clinical personnel to NCQA, CMS, State, and Federal...

About the JobThis is a unique opportunity to work with a top-in-class, award-winning manufacturing company as a Mold Injection Auditor. As a key member of our team, you will be responsible for ensuring the highest quality standards in our production process.Key ResponsibilitiesConduct visual and dimensional inspections to ensure compliance with quality...

Job SummaryWe are seeking a highly skilled Physical Therapist to join our team at California Healthcare Clinical Employee. As a Physical Therapist, you will be responsible for providing high-quality patient care in an outpatient ortho clinic setting.Key ResponsibilitiesProvide physical therapy services to patients in an outpatient settingDevelop and...

Job SummaryWe are seeking a highly skilled Physical Therapist to join our team at California Healthcare Clinical Employee. As a Physical Therapist, you will be responsible for providing high-quality patient care in an outpatient orthopedic setting.Key ResponsibilitiesProvide physical therapy services to patients with various orthopedic conditionsDevelop and...

Job SummaryClinical Management Consultants is seeking a highly skilled Cardiovascular ICU Nurse to join our team in a top hospital for Critical Care specialty. The successful candidate will work in a 10+ bed CVICU that generally has 2-4 open heart surgeries, six days per week.About the RoleThe Cardiovascular ICU Registered Nurse will report to the CVICU...

About the RoleCommonSpirit Health is seeking a skilled RN Clinic Professional to join our team at St. Mary Medical Center. As a member of our interdisciplinary care team, you will provide comprehensive and compassionate care to individuals diagnosed with HIV/AIDS, STDs, and those seeking Biomedical Prevention Services.ResponsibilitiesTriage and Assessment:...

Job OverviewAs a key member of our clinical team, the Clinical Review Nurse Specialist is responsible for evaluating medical documentation to confirm medical necessity and the appropriate level of care. This role involves utilizing MCG/InterQual guidelines, state and federal regulations, billing, and coding standards, as well as Molina policies to ensure...

Job OverviewPosition SummaryUtilizing extensive clinical expertise, the incumbent will be responsible for evaluating documentation to confirm medical necessity and the appropriate level of care in accordance with MCG/InterQual standards, state and federal regulations, billing and coding guidelines, as well as Molina policies. This role involves validating...

About the RoleThe Clinical Services Specialist will be responsible for delivering high-quality direct clinical services, including tele-counseling, to students with Autism Spectrum Disorder (ASD) and/or learning disabilities. This role involves working within the CIP Clinical Framework to provide assessments, support plans, case management, as well as...

About the RoleCHE Behavioral Health Services is seeking a Licensed Clinical Psychologist to join our team in California. As a clinical psychologist, you will have the opportunity to work with a diverse population of patients and provide high-quality mental health services.Key ResponsibilitiesProvide individual and group therapy sessions to patientsConduct...

About the RoleThe Clinical Program Manager Consultant will play a key role in supporting the overall FEP Care Management team as a subject matter expert, while exemplifying Blue Shield of California's leadership behaviors.Key ResponsibilitiesContribute to the Adoption and Improvement of Care Management Electronic Medical RecordsParticipate in go-live...

Job OverviewAs a Clinical Review Nurse, you will leverage your clinical expertise to assess documentation for medical necessity and the appropriate level of care. Your role will involve utilizing MCG/InterQual guidelines, state and federal regulations, billing and coding standards, and Molina policies to validate medical records and claims submitted,...