- Assists with preparing and maintaining health plan criteria for the Campus Medical Directors.
- Understand all aspects of the functionality of Access Express/Heritage Connect with respect to prior authorization and the customer service modules.
- Complete assigned tasks accurately and within specified time limits.
- Maintain smooth working relations with co-workers and supervisors. Be a "Team Player".
- Anticipate future events, set realistic goals, timetables, coordinate activities to ensure smooth work flow and time management.
- Understand all Regal Medical Management policies and procedures to help create and maintain job aids that are consistent with these policies.
- Communicate effectively and interact with the department managers, compliance officer, regional medical directors and staff daily or as indicated regarding all medical management processes.
- Identify and schedule ongoing training sessions for established staff to review processes with the department trainer where deficiencies appear in audits.
- Help to train new nurses, physicians, medical directors, and necessary staff to rapidly learn the Organizations principles of Medical Management and to facilitate the right care at the right time in the right setting.
- Verify that patient confidentiality is maintained by the staff and that HIPPAA compliance is observed at all times.
- Speak clearly, concisely and tactfully on all subjects related to Medical Management.
- Employer-paid comprehensive medical, pharmacy, and dental for employees
- Vision insurance
- Zero co-payments for employed physician office visits
- Flexible Spending Account (FSA)
- Employer-Paid Life Insurance
- Employee Assistance Program (EAP)
- Behavioral Health Services
- 401k Retirement Savings Plan
- Income Protection Insurance
- Vacation Time
- Company celebrations
- Employee Assistance Program
- Employee Referral Bonus
- Tuition Reimbursement
- License Renewal CEU Cost Reimbursement Program
- Business-casual working environment
- Sick days
- Paid holidays
- Mileage
- Active California Nursing License (RN or LVN).
- At least one year of prior authorization/ managed care experience.
- Typing 60 words per minutes with accuracy.
- Knowledge of computers, faxes, printers and all other equipment.
- Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point).
- Ability to deal with responsibility with confidential matters.
- Ability to work in a multi-task, high stress environment.
-
Inpatient Case Manager RN
6 days ago
Heritage Provider Network Northridge, United StatesJob DescriptionPosition Summary:The Inpatient Case Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified patients during an acute care episode.Assesses and develops a plan of care in collaboration with ...
-
Inpatient Case Manager RN
5 days ago
Heritage Provider Network Northridge, United StatesJob Description · Position Summary: · The Inpatient Case Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified patients during an acute care episode. · Assesses and develops a plan of care in collabor ...
-
Case Manager Lead
1 week ago
Regal Medical Group Northridge, United StatesJob Description · Position Summary: · The Lead, Inpatient Transfer Team Case Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified patients during an acute care episode. Assesses and develops a care pl ...
-
Heritage Provider Network Northridge, United StatesJob DescriptionPosition Summary:The Lead Inpatient Transfer Case Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified patients during an acute care episode. Assesses and develops a care plan in collabo ...
-
Case Manager Lead
1 day ago
Regal Medical Group Northridge, United StatesJob Description · Position Summary: · The Lead, Inpatient Transfer Team Case Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified patients during an acute care episode. Assesses and develops a care pl ...
-
Registered Nurse, Inpatient Psychiatric Unit
5 days ago
Los Angeles Jewish Health Reseda, CA, United States Full timeWe value our employees We offer long term employment opportunities with job stability, including supporting and encouraging career growth advancement. We offer Health, Dental and Vision insurance, Paid Time Off, 9 Paid Holidays, 403(b) with Matching Retirement Plan, Life insuranc ...
-
Ingenium Los Angeles, United StatesJob Description · Job DescriptionSalary: $20/hr, starting (DOE) · Office Support Specialist · JOB DESCRIPTION · Job Title: Office Support Specialist Schedule: 40 hrs/week · Job Type: Full-time, 12-months, at-will FLSA Status: Non-Exempt · Reports to: Administrative Office Manag ...
-
Inpatient Case Manager RN
3 weeks ago
Regal Medical Group Northridge, United StatesJob Description · Position Summary: · The Inpatient Case Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified patients during an acute care episode. · Assesses and develops a plan of care in collabor ...
-
National Resident Rn
5 days ago
Northridge Hospital Medical Center Northridge, United States**Overview** · Founded in 1955 Dignity Health - Northridge Hospital Medical Center is a 394-bed acute care nonprofit community hospital located in Northridge California. The hospital offers a full complement of award winning services including the Leavey Cancer Center a cardiovas ...
-
National Resident Rn
1 week ago
Northridge Hospital Medical Center Northridge, United States**Overview** · Founded in 1955 Dignity Health - Northridge Hospital Medical Center is a 394-bed acute care nonprofit community hospital located in Northridge California. The hospital offers a full complement of award winning services including the Leavey Cancer Center a cardiovas ...
-
Rn Transition Fellow
1 week ago
Northridge Hospital Medical Center Northridge, United States**Overview** · Founded in 1955 Dignity Health - Northridge Hospital Medical Center is a 394-bed acute care nonprofit community hospital located in Northridge California. The hospital offers a full complement of award winning services including the Leavey Cancer Center a cardiovas ...
-
School Nurse School LPN Needed
1 week ago
Soliant Calabasas, United StatesMinimum 1+ years nursing experience required. · School Year Special Needs LVN (LVN/LPN) - Calabasas, CA (Start Date: June 17, 2024) · Do you have a passion for supporting students with special needs? · We are seeking a compassionate and dedicated Licensed Vocational Nurse (LVN/LP ...
-
Registered Nurse, Inpatient Psychiatric Unit
1 week ago
Los Angeles Jewish Health Reseda, CA, United States Full timeWe offer Health, Dental and Vision insurance, Paid Time Off, 9 Paid Holidays, 403(b) with Matching Retirement Plan, Life insurance (paid by the company) and a team spirit workplace culture · *Job Overview:* Los Angeles Jewish Health-Auerbach Geriatric Psychiatric Department, a le ...
-
Adjunct - FY24 Phlebotomy Instructor, Non-Credit
3 weeks ago
Los Angeles Trade Technical College Woodland Hills, United StatesLOS ANGELES COMMUNITY COLLEGE DISTRICT · PROFESSIONAL OPPORTUNITIES · PART-TIME POSITION · ADJUNCT - FY24 PHLEBOTOMY INSTRUCTOR,NON CREDIT · APPLICATION CLOSING DATE: OPENED UNTIL FILLED · The Los Angeles Community College District (LACCD) is the largest community college distric ...
-
Certified Nurse Assistant
1 month ago
Los Angeles Jewish Health Reseda, United States Full timeCertified Nurse Assistant (3-11 Full Time) · Certified Nurse Assistant/Restorative Nurse Assistant (C.N.A./R.N.A.) (7am-3pm, 3pm-11pm, 11pm-7am SHIFTS). · Los Angeles Jewish Health · Established in 1912 as a haven for elderly immigrants, the Los Angeles Jewish Health has grown to ...
-
Certified Nurse Assistant
3 weeks ago
Los Angeles Jewish Health Reseda, United States Full timeFull Time 11pm - 7am · We value our employees We offer long-term employment opportunities with job stability, including supporting and encouraging career growth advancement. We offer Health, Dental, and Vision insurance, Paid Time Off, 9 Paid Holidays, 403(b) with a Matching Reti ...
-
Registered Nurse Per Diem
1 week ago
CEDARS-SINAI SAN FERNANDO, United StatesJob Description · Make a difference every single day · When the work you do every single day has a crucial impact on the lives of others, every effort, every detail, and every second matters. This shared culture of passion and dedication pulses through Cedars-Sinai, and it's just ...
-
Physical Therapist
1 month ago
Los Angeles Jewish Health Reseda, United States Full timeLocated at the intersection of Tampa Avenue and Sherman Way in Reseda, Grancell Village is home to over 350 seniors, who are receiving skilled nursing, geriatric psychiatry, and short-term rehabilitation care. It is also the site of the Jewish Home's Brandman Centers for Senior C ...
-
LVN & RN - SUD Rehab Center
2 days ago
Evergreen Recovery Los Angeles, United StatesJob Description · Job DescriptionSalary: 25+ · About Us: · Evergreen Recovery is a leading drug rehabilitation center dedicated to helping individuals overcome addiction and regain control of their lives. Our compassionate and experienced team is committed to providing high-quali ...
-
La Hyperbaric Oxygen Center LLC Calabasas, United States Part timeJob Description · Job DescriptionHello. · We are OxygenWell Hyperbaric and Regenerative Medicine Center. We are opening up a new location in Calabasas. · We are looking for a NP or PA for one day a week to start, however, there are other times we will need coverage too. · The pr ...
Denial Letters Nurse - Northridge, CA, United States - Regal Medical Group, Inc.
![Default job background](https://contents.bebee.com/public/img/bg-user-ex-1.jpg)
Description
Job DescriptionPosition Summary:
The Denial Nurse is responsible for being the "second line" resource for preparing and maintaining health plan criteria for the campus Medical Directors. This includes collaborating with each Health Plan to obtain updated/adequate criteria for each specialty to ensure that appropriate criteria are referenced upon furnishing a denial. This includes questions regarding procedures, training, and processes to assure compliance with RMG/LMG policies and procedures. The Denial Nurse assists the campus Regional Medical Directors and Inpatient Manager/Supervisor with daily operations and management of denials, training, auditing functions, and assuring that all staff provides a level of patient services that meets or exceeds the organization's expectations. Denial nurse will work collaboratively with Heritage and administration on the health plan template process.
Essential Duties and Responsibilities include the following:
RN's $45/hour - $50/hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.
***Sign on bonus for full time Denial Nurses * paid per company policy
$7k for LVNs
$15K for RNs
The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.
Details of participation in these benefit plans will be provided if an employee receives an offer of employment.
If hired, employee will be in an "at-will position" and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.
Full Time Position Benefits:
The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.
Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.
Health and Wellness:
Requirements
Education and/or Experience: