Interviewer jobs at LIFESOURCE BLOOD SERVICES INC

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under general supervision, the Special Investigations Unit Medical Reviewer (SIU Medical Reviewer) performs reviews of medical records and healthcare claims to substantiate or refute the accuracy and compliance with federal and state regulations and contractual requirements of codes billed to identify coding errors and billing discrepancies in relation to incidents of suspected healthcare fraud, waste, and abuse (FWA) reported to IEHP's Compliance Special Investigations Unit (SIU). Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary Hybrid schedule State of the art fitness center on-site Medical Insurance with Dental and Vision Life, short-term, and long-term disability options Career advancement opportunities and professional development Wellness programs that promote a healthy work-life balance Flexible Spending Account - Health Care/Childcare CalPERS retirement 457(b) option with a contribution match Paid life insurance for employees Pet care insurance Key Responsibilities Perform reviews of medical records and healthcare claims, determining the accuracy of codes billed and compliance with appropriate policies, procedures, and regulations. Understand, interpret, analyze, and make determinations concerning use of CDT, CPT, ICD, DRG, REV and HCPCS coding as it relates to potential healthcare FWA schemes. Conduct research relevant to issues under review. Prepare and submit detailed reports with the results of medical reviews, including corrective action recommendations to investigators. Recommendations may include determinations to deny, recover on overpaid claims, risk mitigation strategies, create internal process improvements or provide education to subjects under review. Apply knowledge of healthcare coding conventions, policies, and other areas of vulnerability. Support/participate in provider calls and reinforce medical review findings and provider education. Presents findings to leadership, regulators and law enforcement and assist in legal proceedings, as appropriate. Maintain knowledge of new and relevant regulations, standards, and coding guidelines. Identify inefficiencies in policies or processes and recommend improvements. Maintain confidentiality and discretion in all investigative activities. Support special projects and other duties as assigned. Qualifications Education & Requirements A minimum of two (2) years of experience performing medical reviews of medical records and claims in a healthcare setting Bachelor's degree in Medical Billing/Medical Coding, Nursing, Healthcare Administration, or related field from an accredited institution required In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position This experience is in addition to the minimum years listed in the Experience Requirements above Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), or Certified Coding Specialist (CCS) required One of the following licenses preferred: Possession of an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN Key Qualifications Must have a valid California Driver's license Strong understanding of medical coding, billing practices, and healthcare regulations Thorough understanding of ICD, CPT, HCPCS, DRG, revenue codes, NDC's and other guidelines and general understanding of investigative processes within a healthcare environment are required Knowledge of Medi-Cal and Medicare rules and regulations, and managed care in California is preferred Strong verbal and written communication, interpersonal skills, critical problem-solving skills, and attention to detail Above average proficiency in the use of technology applications, particularly Excel, Word, and others as necessary Detail-oriented with strong organizational and time management abilities. Ability to articulate medical review findings clearly and thoroughly Conduct research in support of medical reviews and make determinations on claims with a high level of accuracy Demonstrated ability to interpret and analyze healthcare data and records Adapt to different technology software and platforms, including anti-fraud solutions Ability to work independently and collaboratively with a team Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.) Pay Range USD $71,572.80 - USD $93,038.40 /Yr.

City/State Norfolk, VA Work Shift Multiple shifts available Sentara Heart Hospital located on the campus of Sentara Norfolk General Hospital is seeking a Registered Nurse for the Cardiac IMCU! The Sentara Heart Hospital, a 112-bed care facility, is #2 for Cardiology services and Heart Surgery in the State of Virginia and ranks #24 in the nation for best heart programs. Interested in learning about the openings for nurses on the Cardiac IMCU? We are hosting an interview day and would love to schedule you. DAY AND NIGHT SHIFT POSITIONS Apply today to learn more about the available interview times. * PLEASE NOTE: This is an invite-only event. For the interview day 12/17/25 please apply for this position & a recruiter will reach out to discuss open positions with you & to schedule for interview times.* The Registered Nurse (RN) is responsible to perform a competent level of nursing care as demonstrated by the critical thinking model known as the nursing process. The standards of practice (assessment, diagnosis, outcomes identification, planning, implementation, coordination of care- teaching and health promotion and evaluation) along with the standards of professional performance (ethics, culturally congruent practice, communication, collaboration, leadership, education, evidence- based practice /nursing research, quality, evaluation, resource utilization, and environmental health) encompass the actions and foundation of professional nursing. The RN possesses clinical knowledge and skills to meet standards as required by specific clinical areas. Up to $20,000 Sign on Bonus available for qualified candidates Cardiac IMCU: This 24-bed unit provides high acuity cardiac care to patients with cardiac arrhythmias, STEMI's, heart failure, chest pain, ICD's, and permanent pacemakers. * Gain experience in atrial fibrillation medication management. Work with state-of-the-art technology. Our entire unit is telemetry wired. * Cardiac Intermediate Care is an ACCN Silver Beacon Award Unit that is recognized for excellence in providing high-quality patient care, and a work environment that fosters teamwork, collaboration, and positivity. Click on the below YouTube link to learn more about Cardiac IMCU. ************************************** Education: * Associate's Degree or Diploma in Registered Nursing (required) * Bachelor of Science Nursing- BSN or MSN (Preferred) Certification/Licensure: * Virginia RN License Virginia or Compact/Multi-State Eligible. * All Direct Care RN's required to have BLS within 90 days of hire. * Critical Care/IMCU ACLS within 1 year of hire Experience: * None required * Previous healthcare experience (preferred) * New Graduate Nurses Welcome New Graduate Nurses welcome to apply! Kickstart your nursing career with Sentara's dynamic 6-month Nurse Residency program, designed specifically for new graduate RNs with less than one year experience. At Sentara we believe in setting our nurses up for success from day one, which is why all new graduates are automatically enrolled-no extra paperwork or applications. The IMCU Residency program combines practical skills with hands-on training, professional development, and mentoring, empowering you to confidently transition into your nursing career. Keywords: #INDEED, Talroo-Nursing, Step down, Cardiac RN, Telemetry Unit, IMCU, Medical Unit, New Graduate RN . Benefits: Caring For Your Family and Your Career * Medical, Dental, Vision plans * Adoption, Fertility and Surrogacy Reimbursement up to $10,000 * Paid Time Off and Sick Leave * Paid Parental & Family Caregiver Leave * Emergency Backup Care * Long-Term, Short-Term Disability, and Critical Illness plans * Life Insurance * 401k/403B with Employer Match * Tuition Assistance - $5,250/year and discounted educational opportunities through Guild Education * Student Debt Pay Down - $10,000 * Reimbursement for certifications and free access to complete CEUs and professional development * Pet Insurance * Legal Resources Plan * Colleagues may have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met Here at Sentara, we are committed to consistently enhancing our training, advancement tracks, work-life benefits, and more. Our goal is to make you feel more excited to be here every day! Sentara Norfolk General Hospital, located in Norfolk, VA, is a 525-bed tertiary care facility that is home to the only Level I Adult Trauma Center and burn trauma unit in Hampton Roads, and also serves as the primary teaching hospital for Eastern Virginia Medical School. In addition to the high-quality heart program at Sentara Heart Hospital, our facility is home to Nightingale Regional Air Ambulance and several other dedicated facilities and specialized services. As a recognized accredited Comprehensive Stroke Center, and Magnet hospital for nursing excellence, our hospital specializes in heart and vascular, neurosciences, neurosurgery, urology, oncology, spine care, advanced imaging, behavioral health, maternity, and women's health, including a state-of-the-art neonatal intensive care unit. Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves. In support of our mission "to improve health every day," this is a tobacco-free environment. For positions that are available as remote work, Sentara Health employs associates in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

Conducts and oversees treatment record and case management record reviews. Trends and analyzes findings for internal and external reporting. Reviews charts and analyzes clinical record documentation. Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for other clinical staff. Collects, analyzes and prepares clinical record information for projects related to assessing the efficiency, effectiveness and quality of the delivery of managed care services. Prepares monthly performance reports. Assists in the planning and implementation of activities to improve delivery of services and quality of care including the development and coordination of in-service education programs for providers and other clinical staff. Provides training, interpretation and support for QI Clinical Reviewer staff. Audits and validates internal audit results and/or corrective action plans. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description. Other Job Requirements Responsibilities RN/BSN or clinical credentials in a behavioral health field. If not an RN, must hold Masters or Doctoral Degree and be a licensed behavioral health professional. Good organization, time management and verbal and written communication skills. Knowledge of utilization management procedures, Medicaid benefits, community resources and providers. knowledge and experience in diverse patient care settings including inpatient care. Ability to function independently and as a team member. Knowledge of ICD and DSM IV coding or most current edition. Ability to analyze specific utilization problems and creatively plan and implement solutions. Ability to use computer systems. 7 or more years of experience post degree in a clinical, psychiatric and/or substance abuse health care setting. Also requires minimum of 4 years of experience conducting utilization management according to medical necessity criteria. General Job Information Title Clinical Reviewer III, Licensed/Remote (Louisiana) Grade 26 Work Experience - Required Clinical, Utilization Management Work Experience - Preferred Education - Required Bachelor's - Nursing, Master's - Social Work Education - Preferred License and Certifications - Required LCSW - Licensed Clinical Social Worker - Care MgmtCare Mgmt, LISW - Licensed Independent Social Worker - Care MgmtCare Mgmt, LMFT - Licensed Marital and Family Therapist - Care MgmtCare Mgmt, LMSW - Licensed Master Social Worker - Care MgmtCare Mgmt, LPCC - Licensed Professional Clinical Counselor - Care MgmtCare Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtCare Mgmt License and Certifications - Preferred Salary Range Salary Minimum: $70,715 Salary Maximum: $113,145 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Conducts and oversees treatment record and case management record reviews. Trends and analyzes findings for internal and external reporting. * Reviews charts and analyzes clinical record documentation. * Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for other clinical staff. * Collects, analyzes and prepares clinical record information for projects related to assessing the efficiency, effectiveness and quality of the delivery of managed care services. * Prepares monthly performance reports. * Assists in the planning and implementation of activities to improve delivery of services and quality of care including the development and coordination of in-service education programs for providers and other clinical staff. * Provides training, interpretation and support for QI Clinical Reviewer staff. * Audits and validates internal audit results and/or corrective action plans. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description. Other Job Requirements Responsibilities RN/BSN or clinical credentials in a behavioral health field. If not an RN, must hold Masters or Doctoral Degree and be a licensed behavioral health professional. Good organization, time management and verbal and written communication skills. Knowledge of utilization management procedures, Medicaid benefits, community resources and providers. knowledge and experience in diverse patient care settings including inpatient care. Ability to function independently and as a team member. Knowledge of ICD and DSM IV coding or most current edition. Ability to analyze specific utilization problems and creatively plan and implement solutions. Ability to use computer systems. 7 or more years of experience post degree in a clinical, psychiatric and/or substance abuse health care setting. Also requires minimum of 4 years of experience conducting utilization management according to medical necessity criteria. General Job Information Title Clinical Reviewer III, Licensed/Remote (Louisiana) Grade 26 Work Experience - Required Clinical, Utilization Management Work Experience - Preferred Education - Required Bachelor's - Nursing, Master's - Social Work Education - Preferred License and Certifications - Required LCSW - Licensed Clinical Social Worker - Care MgmtCare Mgmt, LISW - Licensed Independent Social Worker - Care MgmtCare Mgmt, LMFT - Licensed Marital and Family Therapist - Care MgmtCare Mgmt, LMSW - Licensed Master Social Worker - Care MgmtCare Mgmt, LPCC - Licensed Professional Clinical Counselor - Care MgmtCare Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtCare Mgmt License and Certifications - Preferred Salary Range Salary Minimum: $70,715 Salary Maximum: $113,145 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.