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Quality Compliance Nurse and Compliance Coordinator - Los Angeles, United States - Preferred IPA of California
Description
Job Description
Job DescriptionOpenings for both a Quality Compliance Nurse and a Compliance Coordinator.
QUALITY COMPLIANCE NURSE
PURPOSE:
The Quality and Compliance Nurse is responsible for working with the Medical Director, the VP of Clinical Policy, the QM Committee in developing, implementing, and refining the Quality Management Program. They are also responsible for oversight and management of Health Plan Audits, as well as responding to Appeals and Grievances.
ESSENTIAL DUTIES:
COMPLIANCE COORDINATOR
The Compliance Coordinator is responsible for supporting the Quality Compliance Nurses for audit preparation. This includes review of audit tool, requesting authorization universes and file preparation for audit submission.
Company DescriptionThrifty Management Services is the dedicated MSO for Preferred IPA of California, providing the best possible care management, care coordination, and claims processing services to Preferred IPA and their members. We work with the network's participating physicians to coordinate patient care when a referral is made to a specialist or hospital for diagnosis and treatment. We coordinate patient care across all aspects of the provider network. We provide high quality services to its participating physicians and superior health care to its members.