A Registered Nurse is responsible for understanding complicated medical histories, advanced surgical procedures, pain modalities and thorough nutritional support. Cleveland Clinic is recognized as the No. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world. Cleveland Clinic will assist you by offering tuition reimbursement and cross-training for professional development. Job DescriptionJoin the Cleveland Clinic team at our Hillcrest Hospital, where you will work alongside passionate caregivers and provide patient-first healthcare. +1 216-307-2685,,258874042# United States, Cleveland Certifications: Current state licensure as Registered Nurse (RN). Cleveland Clinic provides what matters most: career growth, delivering world-class care to our patients, continuous learning, exceptional benefits and working for an organization that offers many long-term career paths.$50k-93k yearly est.7d ago
Home Care STNA Ashtabula County Virtual Open House Event Wednesday March 22nd 10:00 AM to 12:00 PM
Minimum one year home care experience preferred. Provides personal care and assists with home care patients, under the supervision of the RN Case Manager or therapist, Initiates and maintains positive relationships with patients customers and co workers.$31k-37k yearly est.10d ago
LPN, Ambulatory Home Care Services Virtual Open House Wednesday 22nd 1:00 PM-3:00 PM
LPN - Licensed Practical Nurse$38k-62k yearly est.10d ago
Inpatient Coding Educator - Remote
Responsible for assuring coding is being performed accurately. Is responsible for assessing coding accuracy and completeness of inpatient medical record documentation by conducting random and focused coding audits; documenting, preparation and timely presentation of audit results. Educates individuals on the rules/regulations associated with coding. Functions as lead coding advisor to Coding Specialists and answers all educational questions timely.
1. Functions as Lead Coding Advisor to assigned HIS Coding Specialists
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Performs, training and quality monitoring of new, established employees and students.
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Responsible for providing timely feedback on the application of coding guidelines, practices, and proper documentation techniques and data quality improvements.
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Performs random coding quality review on monthly basis and provides timely feedback, additional training and education as needed.
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Identifies and trends areas of opportunity for performance improvement for all coders and provides appropriate feedback to management.
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Demonstrates comprehensive understanding of CCs/MCCs, impact on quality reporting, UHDDS guidelines, HACs and PSIs.
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Assists with the analysis of case mix reports and other statistical reports.
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Demonstrates comprehensive understanding of APG, EAPG and LCD\NCD and CCI regulatory edits.
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Responsible for researching errors related to coding or missed documentation from the medical record in order to provide accurate coding guidance to support established processes.
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Assists with the facilitation of scheduled external audits.
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Responsible for designing, implementing, and managing ongoing Departmental monitoring activities and educational programs to ensure proper coding and compliance with all regulatory statutes.
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Performs targeted second level reviews.
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Maintains up to date credentials.
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Maintains updated knowledge of regulatory guidelines and regulations affecting the coding field.
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Maintains knowledge of guidelines and regulations affecting the UHHS Coding Department.
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Participates in educational and informational activities as required.
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Participates in student mentorship programs
2. Performs other duties as assigned such as, assists when needed, with abstracting Medical Records to identify, sequence, and code diagnostic and procedural information timely and accurately.
Qualifications
Education
Associate degree in HIM required. Bachelor’s degree in HIM preferred.
Required Credentials, License, and / or Certifications
RHIT or RHIA required. CCS preferred.
Experience & Knowledge:
5 plus years of ICD-10 coding experience required, preferably in a large academic medical center.
• Thorough, up-to-date clinical skills, current working knowledge of pathology, pharmacology, surgical procedures, etc.
• Excellent written and verbal communication skills required.
• Ability to function independently and as a team player in a fast-paced environment required.
• Must be detail-oriented and organized, with good problem solving ability.
• Notable client service, communication, and relationship building skills required.
Special Skills & Equipment Knowledge:
Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e. printers, copy machine, FAX machine, etc.) required.$52k-78k yearly est.27d ago
Sr. Specialist, Government Contracts (Remote - Candidate must reside in the Omaha, NE area)
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance.$45.4k-88.5k yearly12d ago
Manager, Appeals & Grievances (Remote - Candidate must reside in the State of Iowa)
Ideal Candidate MUST
reside in the
State of Iowa
and have Appeals & Grievance Ops experience/or MCO Ops experience.
For Immediate Consideration:
Please use link below to apply:
https://careers.molinahealthcare.com/job/des-moines/manager-appeals-and-grievances/21726/42628695712
Job Summary
Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member and provider complaints and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid
KNOWLEDGE/SKILLS/ABILITIES
Manages staff responsible for the submission/resolution of member and provider inquiries, appeals and grievances for the Plan. Ensures resolutions are compliant.
Proactively assesses and audits business processes to determine those most effective and efficient at resolving member and provider problems.
Serves as primary interface with stakeholders and business partners and ensures standard processes are implemented.
Oversees preparation of narratives, graphs, flowcharts, etc. to be used for committee presentations, audits and internal/external reports; oversees necessary correspondence in accordance with regulatory requirements.
Maintains call tracking system of correspondence and outcomes for provider and member appeals/grievances; oversees monitoring of each member submission/resolution to ensure all internal and regulatory timelines are met.
REQUIRED EDUCATION:
Bachelor's degree or equivalent experience
REQUIRED EXPERIENCE:
Min. 6 years' experience in healthcare claims review and/or member dispute resolution.
2 years leadership experience
Experience reviewing all types of medical claims (e.g. HCFA 1500, Outpatient/Inpatient UB92, Universal Claims, Stop Loss, Surgery, Anesthesia, high dollar complicated claims, COB and DRG/RCC pricing).
PHYSICAL DEMANDS:
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $57,394 - $111,918 a year*
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$57.4k-111.9k yearly11d ago
Community/Visiting Family Nurse Practitioner
Job Summary
The Care Connections NPs focus on screening and preventive primary care services delivered in the home, community and nursing facility settings. Provides needed care in the environment that patients feel most comfortable and are most receptive including home, nursing facilities, and “pop up” clinic.
The Nurse Practitioner will be required to work primarily in non-clinical settings and provide medical care to all levels of patients. Some programs may focus on specific populations (e.g., adult and geriatric, pediatric, women's health).
Perform comprehensive medical assessments, order appropriate tests/procedures for diagnostic purposes, formulate treatment plans, obtain specialists' consultations as needed, and do appropriate documentations as required. Job roles and responsibilities emphasize a team-based approach to care and support each member of the team being trained to meet the highest level of function allowed by state law.
Knowledge/Skills/Abilities
Duties and Responsibilities (List all essential duties and responsibilities in order of importance)
• Provide general medical care to various and/or specific patient levels - adults, geriatrics and pediatrics.
• Perform comprehensive evaluations including history and physical exams for risk adjustment and other regulatory assessments
• Address both chronic and acute primary care complaints, and able to ascertain medical urgency
• Establish and document reasonable medical diagnoses
• Seek specialty consultation as appropriate
• Order pertinent diagnostic laboratory and radiology testing for the medical diagnosis or presenting symptom; able to work within an environment of limited resources and therefore uses diagnostic tests judiciously and appropriately
• Discuss unusual or unclear symptoms or results with consulting physician in a timely manner
• Accept feedback and direction from the supervising physician
• Create and implements a medical plan of care
• Provides care coordination and preventative care services for geographical as well as virtual targets who are stratified by risk.
• Schedule patient appointments for telehealth or in-person visits when appropriate
• Provide post discharge coordination to reduce hospital readmission rates and emergency room utilization
• Perform face-to-face in-person visits in a variety of settings including home, skilled nursing facilities, and public locations.
• Additionally, perform face-to-face synchronous video communications using Tele-Health platform based on business need and leadership direction
• Order bulk laboratory orders to target specific populations of member.
• Perform alternating on-call coverage to triage any urgent lab results and develop appropriate plan of care
• Participate in community-based “Pop Up Clinics” as way of building relationship with community while addressing gaps in health care
• Collaborate with fellow nurse practitioners to develop best practices to efficiently and effectively carry out work duties
• Actively participate in regional meetings
• Prescribe medications as appropriate
• Remain knowledgeable on current therapies
• Perform timely documentation in medical records in an electronic medical record computer system
• Engage in practices constituting the practice of medicine in collaboration with and under the medical direction and supervision of a licensed physician to the degree required by state laws. May also function as and perform all duties reasonably expected and assigned to an RN such medication administration.
• Work as a partner with supervising physician. The NP is responsible for initiating collaboration, as it is needed.
• The NP is responsible for knowing when a patient needs physician oversight and when the patient's medical condition may be beyond the scope of knowledge of the NP.
Job Qualifications
Required Education
Master's degree in family health from accredited nursing program
Required Experience
• 3-5-year experience as a Registered Nurse and/or Nurse Practitioner, ideally in a home health, community health, or public health setting
• Experience in chronic disease management and preventative care
Required License, Certification, Association
• Completion of Nurse Practitioner program at the Master's level, with a national certification from one of the following organizations: American Academy of Nurse Practitioners; American Nurses Credentialing Center
• Current state-issued license to practice as a Nurse Practitioner; Family NP
Preferred Experience
• Previous experience as Nurse Practitioner, 3-5 years
• Previous experience in Home health as a licensed clinician, especially in management of chronic conditions
• Experience with underserved populations facing socioeconomic barriers to health care
• Fluency in a language in addition to English is plus
• Immunization and phlebotomy skills
Pay Range: $73,101.84 - $142,548.59 a year*
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$73.1k-142.5k yearly8d ago
Clinical Nursing Director - Perioperative Services
Description -
Sign-on bonus eligible position!
Plans, organizes, directs, evaluates and coordinates inpatient-nursing services within a service line. Collaborates with KFHP/H and the Medical Group staff in the development and execution of strategic plans, providing quality care, and managing cost-effective services which are aligned with federal, state, and local regulations. Responsible for achieving the strategic vision for nursing in their assigned areas of accountability. Responsible for the quality of nursing care and services to patients in their assigned areas of responsibility. Accountable for the following areas dependent upon medical center beds and services offered: Adult Services: Med Surg, Dialysis, Clinical Dietician, Critical Care, TCU, RT, ED if applicable. Maternal Child Health: Labor & Delivery, Pediatrics, PICU, NICU, Maternity, and Normal Newborns (may be combined with Perioperative). Perioperative: OR, PACU, Central Sterile, Ambulatory Surgery Centers (may be combined with MCH). Maintains key Relationships with Clinical and Administrative Director peers, Chiefs of Service, other department directors reporting to Assistant Administrators for clinical and operations, regional PCS, AMGAs, community peers.
Essential Responsibilities:
Collaborates with CNO and other medical center management in identifying and implementing innovative models and best practices with an emphasis on quality of care, service improvements and cost reduction.
With TPMG partner, directs development and implementation of quality and utilization standards across the continuum of care to ensure coordinated plans of treatment, patient focused delivery of services and cost effective utilization of necessary services. Builds trust with the nursing team through visibility.
Coordinates with TPMG to provide for the seamless transition of patients across the continuum of care. Establishes partnerships with facility leadership groups. In collaboration with medical staff and facility leadership ensures a superior care experience and a safe environment with patients and staff. Ensures policies, practices, and procedures comply with administrative, legal and regulatory requirements of the Health Plan contract and governmental and accrediting agencies.
Provides clinical and professional oversight for areas of accountability.
Assures successful implementation of organizational strategies such as Hospital Efficiency, Work Place Safety, Supply Cost Initiative including OR Back-log, Patient satisfaction.
Through the hiring, retention, and development of internal staff in areas of accountability, achieves staffing ratios and optimal patient outcomes with minimal dependence on premium pay (overtime and registry/traveler staff).
Mentors nursing managers in development of leadership skills, fiscally accountable staffing/scheduling practices, professional development of staff, and outcomes based practice.
Oversees the development of department standards as identified by regulatory agencies including policies and procedures.
Develops services that achieve a high level of customer satisfaction with emphasis on customer service, highest standards of quality and innovation.
Maintains a state of continuous regulatory readiness.
Manages and resolves human resource, labor relations, employee and department safety and risk management issues.
Enhances nursing practice and patient outcomes through the effective use of clinical practice and GRASP committees.
Participates in developing the hospitals plan for the recruitment and retention of nursing resources to ensure that a sufficient number of qualified staff members are available to meet the needs of the patients.
Utilizes research data to implement clinical changes and the delivery of patient care and member services.
Accesses KP Health Connect to evaluate the quality of care provided. Uses KP Health Connect to manage clinical operations. Monitors quality, appropriateness, and accuracy of KP Health Connect documentation. Maintains role specific KP Health Connect competencies.
Directs the budget and resource allocations for designated departments. Manages the financial performance and identifies and implements strategies to reduce costs and improve quality of care and services.
Communicates effectively as hospitals advocate to members of the community, continually seeking ways to improve and promote the public relations objective of the hospital and marketing services.
Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees.
Qualifications -
Experience
Minimum seven (7) years of nursing experience in patient care.
Minimum five (5) years of management experience required.
Education
Graduate of accredited school of nursing.
Masters in Nursing or Bachelors in Nursing with Masters degree in related field.
License, Certification, Registration
Registered Nurse License (California) required at hire
Additional Requirements:
Demonstrate strong interpersonal communication skills.
Demonstrate ability to lead and manage through influence and change.
Proven ability to deliver results for meeting organizational objectives
Demonstrate knowledge of federal and state laws and regulations such as: Knox-Keene Act, Federal HMO Act, Nurse Practice Act, The Joint Commission, and all applicable Medicare and Medi-Cal regulations.
ACLS, PALS, NRP certification may be required for positions in specific department.
National Certification preferred within 1 year of hire
Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
Magnet/shared governance experience preferred
Managing in a collective bargaining environment preferred
Doctor of Nursing Practice (DNP) or PhD in Nursing preferred
$109k-144k yearly est.14d ago
Research Associate I
Must have own car, valid driver's license and willing to travel throughout Greater Sacramento Area daily with periodic travel to downtown Oakland. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Kaiser Permanente conducts compensation reviews of positions on a routine basis.$57k-82k yearly est.1d ago
Medicaid Actuarial Analyst
Title:
Medicaid Actuarial Analyst
Location:
Remote
Start Date:
As soon as possible
Basic Qualifications:
10+ years Medicaid actuary experience
3+ years of experience with SAS
Risk adjustment experience
Medicaid pricing background
FSA/ASA certification
Knowledge of Chronic Illness and Disability Payment System (CDPS)/CDPS+Rx
Power BI experience preferred
Position Overview
:
This position exists to assist the organization in making data-related decisions by analyzing, manipulating, tracking, internally managing and reporting data within a business process or functional context. This role requires a mix of skills that includes business analysis and data analysis in support of marketing data solutions. This a key role that supports the business ownership of applications as well as the provision of business operations support with our production support teams. The role:
Provides guidance and direction to business partners on solutions and work with engagement managers, other business analysts/SMEs and staff to ensure appropriate solutions are delivered and appropriate business operations support procedures established.
Recommends basic data-oriented solution alternatives to address business problems.
Works with business and technical partners to ensure that the appropriate data is captured, structured, and made available to business users in the most efficient way.
Is a domain expert for one or more systems in data management, and acts as SME in support of Engagement Managers work on requirements and analysis.
Produces documentation and training material for business stakeholders as appropriate.
Carries out root cause analysis of system data problems. Researches and resolves technical and functional issues according to defined prioritization/severity scheme.
Provides 2nd and 3rd tier application support for assigned application(s).
Monitors production batch and ad hoc jobs as required to ensure proper functioning and completion of business operations.
Performs a variety of project related activities, including analysis or preparation of documentation and presentations.
Provides functional direction in data related areas of the operation or project.
May document issues, action items, user requirements, or deliverables from project meetings.
Performs a variety of project related activities, including analysis or preparation of documentation and presentations.
Builds and maintains complex SQL reports written by self and others.
Tests and maintains data integrity across multiple databases (SQL Server, Oracle and external Excel).
Develops reports with accurate, easy to read, useful information that satisfies the client's needs.
Participates significantly in creating tracking and monitoring tools. Participates significantly in creating research plans for data gathering and analysis. Participates significantly in interpreting analyses and developing action plans accordingly.
$70k-90k yearly est.9d ago
Research Associate I
At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Kaiser Permanente conducts compensation reviews of positions on a routine basis. Must have own car, valid driver's license and willing to travel throughout Greater Sacramento Area daily with periodic travel to downtown Oakland. Primary Location: California,Sacramento,S. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.$31.3k-40.5k yearly2d ago
Research Associate I
At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. COMPANY: KAISER TITLE: Research Associate I LOCATION: Oakland, California REQNUMBER: External hires must pass a background check/drug screen. Kaiser Permanente conducts compensation reviews of positions on a routine basis.$57k-83k yearly est.2d ago
Genomic Scientist
$111k-174k yearly est.2d ago
Otolaryngology-General ENT(with Academic Responsibilities) Opportunity- Oakland, CA
$379k-390k yearly5d ago
Executive Compensation Consultant V
$77k-99k yearly est.14d ago
Facilities Services Director
Experience Minimum eight (8) years of experience in management/leadership, preferably in health care or a related facilities services environment.$155k-266k yearly est.12d ago
Technician, Tumor Registry III
+ Mastery of all Tumor Registry Technician I and II job requirements for a minimum of six months.$37k-48k yearly est.36d ago
Technician, Tumor Registry III
+ Mastery of all Tumor Registry Technician I and II job requirements for a minimum of six months.$37k-48k yearly est.36d ago
LPN Bilingual - Primary Care (40 Hours) Clackamas *REMOTE*
Participates with the Health Care Team in delivering quality and customer focused care to patients in a manner which reflects Kaiser Permanente's organizational and nursing mission, vision and values.$46k-59k yearly est.60d+ ago
LPN Bilingual - Primary Care (40 Hours) Clackamas *REMOTE*
Participates with the Health Care Team in delivering quality and customer focused care to patients in a manner which reflects Kaiser Permanente's organizational and nursing mission, vision and values.$46k-59k yearly est.60d+ ago
