Lead, Med Ref UM QMS
7 days ago
The lead Medication Referral Nurse, Utilization Management & Quality Monitoring Specialist is responsible for assisting with the oversight of daily operations and providing training and support to Medication Referral Coordinators. This role will provide high level, complex referral support and coordination to the manager; will serve as a liaison between the Referral Department, the requesting providers, and the Medication Referral team. Will serve as a subject matter expert to staff, assist with providing clinical staff development, and assist with health plan audits and quality improvement reports as necessary..Professional DutiesFacilitate open communication during team meetings and model collaborative problem-solving.Provide guidance and serve as a resource to Referral Coordinators. Assist with coverage and training as needed to support the daily operations of the departments.Support leadership by guiding referral staff in daily operations, coordinating staffing coverage within assigned areas, and offering input for timely and accurate performance reviews.Act as the primary resource for infusion/injection related questions pertaining to medication referral process, contracts, and benefits provider/member questions.Assist in the development of education material and training of all new employees.Participate in continuous quality improvement activities and audit evaluations.Assist in tracking, prioritizing, and responding to daily departmental requests to ensure timely resolution of UM/health plan audits.Assists management with the development of policy and procedures as required.Serve as a liaison with other departments to troubleshoot and resolve referral issues, escalating complex matters to management as needed.Support management by tracking referral turnaround times and accuracy by providing oversight of daily workflow to minimize processing errors in accordance with all regulations and protocols.Support leadership in maintaining a positive work environment by assisting with employee concerns, facilitating resolution of minor conflicts, and collaborating with management to address conflict resolution and referral-related issues.Perform other duties assigned.Be knowledgeable about your job so that you can serve others effectivelyBe accountable for your workDemonstrate appropriate body language and tone of voiceQualificationsCurrent California LVN license required.Minimum of 3 years of healthcare experience required.Minimum of 2 years of experience in Quality, Utilization Review or Utilization Management departments with knowledge of Medicare and Managed Care rules required.Basic computer skills. Knowledge of Microsoft Word and Excel. Experience with EZ- Cap, Q Auth, and Next Gen is preferred.Exceptional communication, detail-oriented, critical thinking and problem-solving skills. Excellent customer service and telephone etiquette.Bilingual, preferred but not required.Ability to manage time effectively and reprioritize tasks in order to meet deadlines.At the discretion of DOHC/FHC management, this position has the potential to be a full or hybrid telecommuting position.Physical DemandstypeSittingApproximately 70% of daytypeStandingApproximately 15% of daytypeWalkingApproximately 15% of daytypeLifting0 - 20 lbs (charts, supplies) - approximately 10% of daytypeBendingApproximately >10% of day. Kneeling
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Specialist, QMS
2 days ago
Colorado Springs, Colorado, United States Xylem Full time $75,000 - $85,000 per yearXylem is a Fortune 500 global water solutions company dedicated to advancing sustainable impact and empowering the people who make water work every day. As a leading water technology company with 23,000 employees operating in over 150 countries, Xylem is at the forefront of addressing the world's most critical water challenges. We invite passionate...
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Specialist, QMS
4 weeks ago
Colorado Springs, United States Colorado Staffing Full timeQuality Management Systems SpecialistXylem is a Fortune 500 global water solutions company dedicated to advancing sustainable impact and empowering the people who make water work every day. As a leading water technology company with 23,000 employees operating in over 150 countries, Xylem is at the forefront of addressing the world's most critical water...
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Travel Nurse RN
6 days ago
Palm Springs, United States Uniti Med Full timeUniti Med is seeking a travel nurse RN Labor and Delivery for a travel nursing job in Palm Springs, California.Job Description & RequirementsSpecialty: Labor and DeliveryDiscipline: RNStart Date: ASAPDuration: 13 weeksShift: daysEmployment Type: TravelUniti Med is looking for a Travel Labor & Delivery RN in Palm Springs, CA.This assignment lasts 13 weeks and...
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Bloomington Springs, United States K.A. Recruiting Full timeLooking for a new NMT job? My name is Leah and I'm a healthcare recruiter, I'm here to help! I have a Nuclear Med Tech available near Bloomington Springs, Tennessee! Details - Full-time and permanent - Shift: Days - Opportunities for growth - Full, comprehensive benefits package (PTO, health insurance, etc.) Requirements - College degree - ARRT/NMT cert -...
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Bloomington Springs, United States K.A. Recruiting Full timeLooking for a new NMT job? My name is Leah and I'm a healthcare recruiter, I'm here to help! I have a Nuclear Med Tech available near Bloomington Springs, Tennessee! Details - Full-time and permanent - Shift: Days - Opportunities for growth - Full, comprehensive benefits package (PTO, health insurance, etc.) Requirements - College degree - ARRT/NMT cert -...
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Bloomington Springs, TN, United States K.A. Recruiting Full timeLooking for a new NMT job? My name is Leah and I'm a healthcare recruiter, I'm here to help! I have a Nuclear Med Tech available near Bloomington Springs, Tennessee! Details - Full-time and permanent - Shift: Days - Opportunities for growth - Full, comprehensive benefits package (PTO, health insurance, etc.) Requirements - College degree - ARRT/NMT cert -...
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Bloomington Springs, TN, United States K.A. Recruiting Full timeLooking for a new NMT job? My name is Leah and I'm a healthcare recruiter, I'm here to help! I have a Nuclear Med Tech available near Bloomington Springs, Tennessee! Details - Full-time and permanent - Shift: Days - Opportunities for growth - Full, comprehensive benefits package (PTO, health insurance, etc.) Requirements - College degree - ARRT/NMT cert -...
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Bloomington Springs, TN, United States K.A. Recruiting Full timeLooking for a new NMT job? My name is Leah and I'm a healthcare recruiter, I'm here to help! I have a Nuclear Med Tech available near Bloomington Springs, Tennessee! Details - Full-time and permanent - Shift: Days - Opportunities for growth - Full, comprehensive benefits package (PTO, health insurance, etc.) Requirements - College degree - ARRT/NMT cert -...
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Bloomington Springs, TN, United States K.A. Recruiting Full timeLooking for a new NMT job? My name is Leah and I'm a healthcare recruiter, I'm here to help! I have a Nuclear Med Tech available near Bloomington Springs, Tennessee! Details - Full-time and permanent - Shift: Days - Opportunities for growth - Full, comprehensive benefits package (PTO, health insurance, etc.) Requirements - College degree - ARRT/NMT cert -...
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Bloomington Springs, TN, United States K.A. Recruiting Full timeLooking for a new NMT job? My name is Leah and I'm a healthcare recruiter, I'm here to help! I have a Nuclear Med Tech available near Bloomington Springs, Tennessee! Details - Full-time and permanent - Shift: Days - Opportunities for growth - Full, comprehensive benefits package (PTO, health insurance, etc.) Requirements - College degree - ARRT/NMT cert -...
