Organization: SCAH-Sutter Care at Home - UT As the Clinical Referral Specialist, this person frequently interacts with referral sources, other members of the referral center staff, home health, Advanced Illness Management (AIM) and hospice staff across offices and all others necessary to facilitate the start of patient care.$62k-68k yearly est.3h ago
Sr Specialist, Delegation Oversight (Claims)- REMOTE - CA ONLY
Responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with DMHC and DHCS requirements including delegation standards and requirements contained in the Molina Medical Compliance and Fraud, Waste and Abuse Program.
This position is in California and is in Claims.
KNOWLEDGE/SKILLS/ABILITIES
Coordinates, conducts, and documents delegation assessments as necessary to comply with state, federal, NCQA, and any other applicable requirements.
Prepares status reports from Delegated Entities. Develops corrective action plans when deficiencies are identified, and documents follow-up to completion. Ensures compliance with reporting requirements by tracking the receipt and completeness of reports.
Develops corrective action plans when compliance issues are identified, and document follow-up to completion.
Assists with meetings of the Delegation Oversight Committee, including the preparation of documents for committee oversight of delegated functions.
Works with Network Management team to develop and maintain delegation agreements and assessment tools.
Prepares delegation oversight document evidence for state monitoring visits and NCQA accreditation surveys and participates on Molina's work team.
JOB QUALIFICATIONS
Required Education
Bachelor's Degree or equivalent combination of education and experience.
Required Experience
3+ years managed care experience.
Min. 1 year experience completing delegation oversight assessment/ audits.
Data analysis experience.
Required License, Certification, Association
Valid State Driver's License
Preferred Education
Bachelor's Degree in Business or Health Care related field.
Preferred Experience
5 years managed care experience.
2 years' experience completing delegation oversight assessments/audits.
Quality management/regulatory experience with increasing responsibility.
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.
#PJHPO #Li-BeMore
Pay Range: $45,390.49 - $88,511.46 a year*
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.$45.4k-88.5k yearly46d ago
Remote Family Nurse Practitioner (Field Visits Required)
The Care Connections Nurse Practitioners 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.
Provide general medical care to various and/or specific patient levels - adults and geriatric.
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 diagnostic and/or therapeutic procedures within his/her level of training and expertise, and as outlined on the practice agreement and written protocol with the supervising physician
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 Telehealth 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
Drive up to 120 miles a day on a regular basis. There may be drives beyond 120 miles as part of Extended Mileage Special Project days.
Obtain cross state license in other states besides home state based on business need.
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
Master's degree in family health from accredited nursing program
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
Experience in chronic disease management and preventative care
REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:
Completion of Nurse Practitioner program at the master's level, with an active and unrestricted 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 Family Nurse Practitioner
Current Basic Life Support for Healthcare Professional certification
Current unrestricted driver's license
PREFERRED EXPERIENCE:
3-5-year experience as a Registered Nurse and/or Nurse Practitioner, ideally in a home health, community health, or public health setting
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
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.$120k-149k yearly est.1d ago
Medical Director-Behavioral Health ( Remote PT Psychiatrist)
Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and chemical dependency services and assists with implementing integrated Behavioral Health care management programs. 2 years previous experience as a Medical Director.$161.9k-315.7k yearly1d ago
Business Intelligence Developer
is the multi-specialty physician organization of BJC HealthCare and includes over 600 doctors and advanced practice providers who are affiliated with the top-ranked hospitals in the area. BJC Medical Group physicians are trained and certified in over 25 medical specialties and serve patients in more than 125 locations in the greater St. Louis, mid-Missouri and southern Illinois areas. BJC is hiring for a Business Intelligence Developer.$82k-99k yearly est.3d ago
Service Delivery Manager - Compute/Cloud
BJC is hiring for a Service Delivery Manager. By ''Caring for Systems that Care for People'', BJC HealthCare Information Services (IS) is a key enabler of the mission, strategy and operating excellence that is associated with BJC HealthCare. BJC s patients have access to the latest advances in medical science and technology through a formal affiliation between Barnes-Jewish Hospital and St. Louis Children s Hospital with the renowned Washington University School of Medicine, which consistently ranks among the top medical schools in the country. is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri regions.$78k-101k yearly est.22d ago
Lead Business Analyst
BJC s patients have access to the latest advances in medical science and technology through a formal affiliation between Barnes-Jewish Hospital and St. Louis Children s Hospital with the renowned Washington University School of Medicine, which consistently ranks among the top medical schools in the country. BJC is hiring for a Lead Business Analyst. is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri regions.$82k-99k yearly est.12d 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.19d ago
Research Associate I
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. 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. 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. 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.$31.3k-40.5k yearly9d ago
Research Associate I
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. COMPANY: KAISER TITLE: Research Associate I LOCATION: Oakland, California REQNUMBER: External hires must pass a background check/drug screen.$57k-83k yearly est.9d ago
Behavioral Health Therapist - LPCC, LCSW, LMFT
+ Is knowledgeable of KP and community resources. + Licensed Marriage and Family Therapist (California) OR Licensed Professional Clinical Counselor (California) OR Licensed Clinical Social Worker (California)$74k-88k yearly est.35d ago
SCPMG Complete Care Support Program Undergraduate Intern
At any time, Kaiser Permanente reserves the right to re-evaluate 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. While remote, finalists MUST reside in one of the following states to be eligible for employment with Kaiser Permanente: CA or HI. LOCATION: Pasadena, California Report location to pick up laptop and badge: 393 E. Walnut St, 4th Floor Pasadena, CA 91188 TITLE: SCPMG Complete Care Support Program Undergraduate Intern$51k-64k yearly est.9d ago
SCPMG Complete Care Support Program Undergraduate Intern
At any time, Kaiser Permanente reserves the right to re-evaluate 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. While remote, finalists MUST reside in one of the following states to be eligible for employment with Kaiser Permanente: CA or HI. LOCATION: Pasadena, California Report location to pick up laptop and badge: 393 E. Walnut St, 4th Floor Pasadena, CA 91188 TITLE: SCPMG Complete Care Support Program Undergraduate Intern$51k-64k yearly est.9d ago
Project Management Graduate Intern
LOCATION: Burbank, California At Kaiser Permanente, you'll forge lasting relationships with colleagues across the organization while enjoying the opportunity to grow your experience and hone your expertise on assignments that have real impact. TITLE: Project Management Graduate Intern While remote, finalists MUST reside in one of the following states to be eligible for employment with Kaiser Permanente: CA, OR, WA, HI, CO, GA, MD, VA, CT, DC, or IL. The KP Military Health's team's primary purpose is to provide affordable, accessible, high-quality care and coverage to active and retired military and their families in all Kaiser Permanente markets.$33k-38k yearly est.23d ago
Project Management Graduate Intern
LOCATION: Burbank, California At Kaiser Permanente, you'll forge lasting relationships with colleagues across the organization while enjoying the opportunity to grow your experience and hone your expertise on assignments that have real impact. TITLE: Project Management Graduate Intern While remote, finalists MUST reside in one of the following states to be eligible for employment with Kaiser Permanente: CA, OR, WA, HI, CO, GA, MD, VA, CT, DC, or IL. The KP Military Health's team's primary purpose is to provide affordable, accessible, high-quality care and coverage to active and retired military and their families in all Kaiser Permanente markets.$33k-38k yearly est.23d ago
Systems Solution & Deployment Undergraduate Student Temporary
LOCATION: Pasadena, California TITLE: Systems Solution & Deployment Undergraduate Student Temporary At any time, Kaiser Permanente reserves the right to revaluate and change job descriptions, or to change such positions from salaried to hourly pay status.$46k-74k yearly est.32d ago
Systems Solution & Deployment Undergraduate Student Temporary
LOCATION: Pasadena, California TITLE: Systems Solution & Deployment Undergraduate Student Temporary At any time, Kaiser Permanente reserves the right to revaluate and change job descriptions, or to change such positions from salaried to hourly pay status.$46k-74k yearly est.32d ago
Software Development Undergraduate Intern
LOCATION: Pasadena, California TITLE: Software Development Undergraduate Intern At Kaiser Permanente, you'll forge lasting relationships with colleagues across the organization while enjoying the opportunity to grow your experience and hone your expertise on assignments that have real impact. While remote, finalists MUST reside in a one of the following states to be eligible for employment with Kaiser Permanente: CA, CO, DC, GA, HI, MD, NY, OR, VA, or WA.$40k-48k yearly est.35d ago
Software Development Undergraduate Intern
LOCATION: Pasadena, California TITLE: Software Development Undergraduate Intern At Kaiser Permanente, you'll forge lasting relationships with colleagues across the organization while enjoying the opportunity to grow your experience and hone your expertise on assignments that have real impact. While remote, finalists MUST reside in a one of the following states to be eligible for employment with Kaiser Permanente: CA, CO, DC, GA, HI, MD, NY, OR, VA, or WA.$40k-48k yearly est.35d ago
IT Project Management Undergraduate Intern
LOCATION: Pasadena, California TITLE: IT Project Management Undergraduate Intern At Kaiser Permanente, you'll forge lasting relationships with colleagues across the organization while enjoying the opportunity to grow your experience and hone your expertise on assignments that have real impact. While remote, finalists MUST reside in a one of the following states to be eligible for employment with Kaiser Permanente: CA, CO, DC, GA, HI, MD, NY, OR, VA, or WA.$33k-38k yearly est.43d ago
