Compliance Nurse Lead
3 weeks ago
The Utilization Management Nurse, Senior plays a critical role in reviewing medical documents and applying clinical criteria to ensure post-service prepayment facility claims comply with contract requirements and industry standards. This position requires a unique blend of clinical expertise and analytical skills.
Responsibilities
- Review medical documents and apply clinical criteria for determining suitable level of care
- Audit hospital itemized bills for comprehensive line-by-line reviews
- Manual claims processing on exceptions
Requirements
- Bachelor's of Science in Nursing or advanced degree
- Current California RN License
- Typically 5+ years of relevant experience and college degree or equivalent
- Active AAPC or ADHIMA coding certification (e.g., CPC-CIC or COC) with procedure coding experience (HCPCS/CPT)
Salary Range:
$87,230.00 - $130,900.00 per year, depending on location and experience.
-
Compliance Expert
3 weeks ago
Oakland, California, United States Fivetran Full timeAbout the RoleFivetran is seeking a highly experienced Compliance Counsel to lead our global compliance efforts. This is an exciting opportunity for a talented attorney to shape governance and compliance across our growing organization.This full-time position will report to our Senior Director, Associate General Counsel and can be based out of our Denver, CO...
-
Compliance Expert
2 weeks ago
Oakland, California, United States Jacobian Engineering Inc Full timeAs a highly experienced Compliance Expert, you will play a pivotal role in managing comprehensive compliance programs for multiple commercial clients at Jacobian Engineering Inc. Your expertise in regulatory frameworks and risk management principles will enable our clients to navigate complex compliance landscapes.The ideal candidate will have a strong...
-
Compliance Management Specialist
2 weeks ago
Oakland, California, United States Dudek Full timeAbout the PositionWe are seeking a senior-level professional to lead our environmental compliance services team.This role requires strong leadership and management skills, as well as expertise in environmental compliance and regulations.You will be responsible for developing and implementing environmental compliance management plans and permit...
-
Business Compliance Officer
2 weeks ago
Oakland, California, United States Altais Health Solutions Full timeJob OverviewAltais Health Solutions seeks a qualified Business Integrity and Compliance Specialist to join our Compliance department. This role involves leading investigations into potential fraud, waste, and abuse (FWA), utilizing data analysis to monitor compliance risks, and collaborating with other departments to ensure alignment with compliance...
-
EHS Compliance Manager
2 weeks ago
Oakland, California, United States Twelve Full timeJob DescriptionTwelve is a new kind of chemical company built for the climate era. Our breakthrough technology eliminates emissions by turning CO2 into essential products. We are a team of scientists, engineers, and problem solvers on a mission to address climate change.About the PositionThe Senior EHS Specialist will work closely with the EH&S Director to...
-
Compliance and Integrity Analyst
2 weeks ago
Oakland, California, United States Altais Health Solutions Full timeAbout UsAt Altais Health Solutions, we're dedicated to revolutionizing the healthcare system for physicians, advanced care providers, patients, and the clinical community. We invite applications from bold and curious individuals who share our passion for enabling better healthcare experiences.This role offers an exciting opportunity to join our Compliance...
-
Nurse Manager Lead
3 weeks ago
Oakland, California, United States Alameda Health System Full timeAbout the Role:We are seeking an experienced Clinical Nurse Director to lead our nursing team at Alameda Health System. This is a key leadership role that requires strong clinical skills, excellent communication and interpersonal skills, and the ability to manage multiple priorities in a fast-paced environment.The estimated salary for this position is...
-
Perioperative Nursing Specialist Lead
3 weeks ago
Oakland, California, United States Diverse Lynx Full timeNursing Career Opportunity: Perioperative Nursing Specialist Lead at Diverse Lynx Diverse Lynx is seeking an experienced professional to lead our perioperative nursing team. As a Perioperative Nursing Specialist Lead, you will play a key role in promoting nursing education and development within the organization.Estimated Salary: $140,000 per year. The...
-
Compliance Risk Management Specialist
4 weeks ago
Oakland, California, United States Blue Shield Of California Full timeYour RoleCompliance Program OversightThe Compliance Audit Services team at Blue Shield of California Promise Health Plan is responsible for ensuring the effective implementation and maintenance of our Compliance Program. As a Compliance Risk Management Specialist, you will report to the Senior Director, Compliance Audit Services, and play a key role in...
-
Medical Device Compliance Manager
2 weeks ago
Oakland, California, United States Collabera Full timeCareer Opportunities at CollaberaJob DescriptionWe are a leading provider of Software Engineering Solutions and are seeking an experienced Regulatory Expert to join our team. As a Regulatory Expert, you will be responsible for ensuring compliance with US FDA and international regulations, performing regulatory assessments, and collaborating with...
-
Healthcare Compliance Specialist
2 weeks ago
Oakland, California, United States Blue Shield of California Full timeAbout the RoleThe Privacy Program Specialist, Consultant at Blue Shield of California is responsible for advancing and enforcing the company's Privacy Program.Key Responsibilities:Oversight of compliance with state and federal privacy laws, including HIPAA and HITECH.Auditing and monitoring compliance with the Privacy Program, developing corrective action...
-
Certified Payroll Compliance Expert
2 weeks ago
Oakland, California, United States LHH Recruitment Solutions Full timeJob OverviewLHH Recruitment Solutions is a leading recruitment agency seeking an experienced Certified Payroll Compliance Expert to join our team in Oakland, California. In this role, you will be responsible for ensuring compliance with state and federal payroll regulations, managing payroll processes, and working closely with subcontractors to resolve labor...
-
Healthcare Compliance and Privacy Expert
2 weeks ago
Oakland, California, United States Blue Shield of California Full timeJob Description:The role of the Privacy Program Specialist, Consultant at Blue Shield of California requires a highly skilled professional to oversee the organization's compliance with state and federal privacy laws.Key Responsibilities:Oversight of Blue Shield's compliance with HIPAA, HITECH, and CMIA regulationsAuditing and monitoring of the Privacy...
-
Compliance Audit Expert
2 weeks ago
Oakland, California, United States Blue Shield of California Full timeJob OverviewThe Compliance Audit Services team at Blue Shield of California oversees all functions of an effective Compliance Program, ensuring compliance with contractual and regulatory requirements.About the RoleYou will report to the Senior Director, Compliance Audit Services, and be responsible for monitoring and oversight of operational business areas....
-
Healthcare Compliance Expert
4 weeks ago
Oakland, California, United States Blue Shield Of California Full timeAbout Blue Shield of CaliforniaAs a leading healthcare organization, Blue Shield of California is committed to protecting the privacy and security of our members' personal health information. We are seeking an experienced Healthcare Compliance Expert to join our team as a Privacy Program Specialist.Responsibilities:Oversee Blue Shield's compliance with state...
-
Air Quality Regulatory Compliance Specialist
2 weeks ago
Oakland, California, United States SSA Marine Full timeJob Description:Air Quality Regulatory Compliance SpecialistAbout SSA Marine:SSA Marine is a leading provider of marine terminal services, with a strong commitment to environmental stewardship and regulatory compliance.Job Summary:The Air Quality Regulatory Compliance Specialist will be responsible for overseeing and implementing applicable State and Local...
-
Nurse Manager Lead
3 weeks ago
Oakland, California, United States Elder Care Alliance Full timeAbout Our OpportunityWe are seeking an experienced Nurse Manager Lead to join our team at Elder Care Alliance. As a key member of our leadership team, you will be responsible for overseeing the delivery of high-quality care to our residents.Key ResponsibilitiesDevelop and implement strategic plans to improve resident care outcomesLead and supervise a team of...
-
Risk and Compliance Strategist
3 weeks ago
Oakland, California, United States Ottimate Full time**Company Overview:**Ottimate, a leading fintech company, is seeking an experienced Director of Risk and Fraud to lead our fraud and payments risk program. Our innovative technology, including Artificial Intelligence, Payment Tech, and Neural Networks, is transforming entire industries.The ideal candidate will have a strong background in risk management or...
-
Lead Attorney
2 weeks ago
Oakland, California, United States East Bay Childrens Law Offices Full timeJob OverviewWe are seeking a seasoned Lead Attorney to join our team at East Bay Children's Law Offices, Inc. As a key member of our leadership team, you will oversee our law practice and ensure compliance with our core mission.This role involves supervising staff members, including attorneys in each dependency courtroom, the probate attorney, and...
-
Lead Accounting Professional
2 weeks ago
Oakland, California, United States PsiNapse Technology, Ltd. Full timeJob Overview: We are seeking a Lead Accounting Professional to join our team at PsiNapse Technology, Ltd. in Oakland. This role is a 6-month contract position, and we offer competitive compensation and benefits.About the Job: As a Lead Accounting Professional, you will be responsible for managing advanced accounting tasks, including budgeting, finance,...