Concurrent Review Nurse Specialist
5 days ago
We are seeking a skilled Concurrent Review Nurse to join our team at Health Plan San Joaquin. As a key member of our Long-Term Care team, you will be responsible for conducting concurrent reviews of inpatient activities, ensuring that member care is rendered at the most appropriate level, and collaborating with providers to resolve care issues.
Key Responsibilities- Conduct onsite and/or telephonic concurrent reviews of inpatient activities
- Ensure member care is rendered at the most appropriate level, in compliance with HPSJ, regulatory, and contractual requirements
- Collaborate with providers to resolve care issues and escalate as necessary
- Make timely and appropriate recommendations regarding transfers, level of care, and discharge planning
- Research and resolve adjudication issues in an accurate and timely manner
- Document activities in appropriate HPSJ systems, according to standards
- Track data and compile reports as required
- Graduation from an accredited nursing school
- At least three years of clinical experience as an RN in a hospital or clinic
- Acute care or Skilled Nursing experience
- Long Term Care experience
- Unrestricted California Registered Nurse license
- Valid California driver license and reliable transportation or ability to obtain transportation on demand
- Experience in case management, utilization management, or discharge planning
- Experience as a clinician in a managed care setting
- Experience working with Medi-Cal and/or MediCare populations
- Competitive salary
- Robust and affordable health/dental/vision benefits
- Generous paid time off and holidays
- CalPERS retirement pension program
- Education and training reimbursement
- Access to exclusive discount mall
We are an equal opportunity employer and value diversity in our workplace. Employment decisions are made on the basis of qualifications and merit. We prohibit discrimination based on color, race, gender, religion, marital status, registered domestic partner status, age, national origin, physical or mental disability, medical condition, sex, genetic information, sexual orientation, military or veteran status, political affiliation, or any other characteristic made unlawful by applicable Federal, State, or local laws.
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Concurrent Review Nurse
2 weeks ago
French Camp, Mississippi, United States Health Plan San Joaquin Full timeJob SummaryWe are seeking a skilled Concurrent Review Nurse to join our team at Health Plan San Joaquin. As a key member of our Long-Term Care team, you will play a critical role in ensuring that our members receive high-quality, cost-effective care.Key ResponsibilitiesConduct concurrent reviews of inpatient activities to ensure compliance with HPSJ,...
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Interim Neonatal Clinical Nurse Specialist
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Concurrent Review Nurse
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French Camp, United States Health Plan San Joaquin Full timeThe expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. This role is remote; However, candidates MUST reside in California.What You Will Be Doing: Under general supervision, conducts onsite and/or telephonic concurrent review of inpatient activities. In addition, this...
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French Camp, California, United States Health Plan San Joaquin Full timeJob SummaryWe are seeking a highly skilled Quality Assurance Specialist to join our team at Health Plan San Joaquin. As a Quality Assurance Specialist, you will be responsible for auditing claims data and adjustments for accuracy of input and adjudication, and facilitating the processing of assigned claims.Key ResponsibilitiesReview claims, appeals, refunds,...
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