- Confirm member care plans with providers and identify potential issues for resolution.
- Collaborate with providers to resolve care issues, escalating when necessary.
- Make timely and informed recommendations regarding transfers, level of care, and discharge planning.
- Escalate non-standard requests to Medical Director for review and approval or denial of services.
- Research and resolve adjudication issues accurately and efficiently.
- Document activities in accordance with HPSJ standards.
- Track data and compile reports as required.
- Strong clinical skills in line with California scope of practice guidelines for RNs.
- The ability to read, interpret, and apply complex written regulations, guidelines, and other materials.
- Excellent communication and problem-solving skills.
- Ability to work independently and as part of a team.
- A competitive salary of $83,000 - $105,000 per annum, depending on experience.
- A comprehensive benefits package, including medical, dental, and vision insurance.
- Paid time off, flexible holidays, and retirement plan options.
- Ongoing education and training opportunities to support your career growth.
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Travel CT Technologist
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Genie Healthcare Modesto FreelanceGenie Healthcare is seeking a travel CT Technologist for a 13-week assignment in Modesto, California. · Job Details · Specialty: CT Technologist · Discipline: Allied Health Professional · Duration: 13 weeks · Hours: 40 hours per week · Shift: 10 hours, days · The position require ...
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Travel Electrophysiology Technician
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Wound, Burn and Ostomy Physician
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Advantage Surgical and Wound Care ModestoJob Title: Part Time Wound Care Specialist · About the Job · We are seeking a skilled Part Time Wound Care Specialist to join our team in Modesto/Sonora areas. As a Wound Care Specialist, you will be responsible for managing wound care in nursing home environments. · Responsibili ...
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Travel Nurse RN
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LanceSoft Modesto FreelanceLanceSoft is seeking a travel nurse with RN Labor and Delivery expertise for a temporary position in Modesto, California. · Job Details · Specialty: Labor and Delivery · Discipline: RN · Duration: 13 weeks · Shift: 12 hours, nights (07:00 PM to 07:30 AM) · Hours per week: 36 · Ab ...
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Travel Nurse RN
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LanceSoft Modesto, CA FreelanceLanceSoft is seeking a travel nurse RN ED - Emergency Department for a travel nursing position in Modesto, California. · Job Summary · This travel nursing job requires a skilled and compassionate Registered Nurse (RN) to work in the Emergency Department of a hospital in Modesto, ...
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Travel Cath Lab Technologist
1 day ago
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Psychiatry - Geriatrics Physician
5 days ago
ProLocums ModestoPsychiatry Specialist · We are seeking a skilled Psychiatry Specialist to join our team at {company}. · Job Summary · The Psychiatry Specialist will provide high-quality patient care in a fast-paced clinical setting. Responsibilities include evaluating and treating patients with ...
- Integrity Healthcare Modesto
Job Summary · We are seeking a skilled professional to join our team of board-certified neonatologists and newborn care specialists. Our multidisciplinary approach provides highly specialized medical and surgical services for pediatric conditions, from routine to complex cases. · ...
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Registered Nurse
5 days ago
Memorial Medical Center - AH ModestoJob Title: Registered Nurse · Job Specialty: Vascular Access Therapy - PICC Specialist · Job Duration: 13 weeks · Shift: Day 3x12-hour (06:45 - 19:15) · Salary: $2,842.00 per week · We are seeking a highly skilled Registered Nurse with experience in vascular access to join our te ...
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Hand Surgeon Independent
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Concentra ModestoHand Surgeon Independent 1099 · Join Concentra, one of the largest healthcare companies in the nation, as an independent contractor hand surgeon. This contract position complements your current practice by offering flexible scheduling for approximately 4 hours per week or biweekl ...
- Sutter Health Modesto
Education Specialist · Position Overview · We are seeking an experienced Education Specialist to coordinate and deliver educational activities that promote the competency and development of Sutter Health's nursing staff. · Job Description · Assesses, plans, develops, implements, ...
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Anesthesiology Physician
5 days ago
SUMO Medical Staffing ModestoJob Title: Anesthesiology Specialist · Location: California · Job Type: Locum Tenens · Job Description: · We are seeking an experienced Anesthesiology professional to provide coverage in the Modesto area. The successful candidate will work 24-hour shifts, with a combination of 10 ...
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Travel Nurse RN
6 hours ago
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Psychiatric-Mental Health Physician
6 days ago
DocCafe Modesto**Physician - Psychiatric-Mental Health Job Description**DocCafe has an immediate opening for a Physician - Psychiatric-Mental Health position in Modesto, California. This is a great opportunity to advance your healthcare career. · Salary: · $200 - $215 per hour. · Job Responsibi ...
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Travel Nurse RN
6 hours ago
Gifted Healthcare ModestoJob Title: · Registered Nurse (RN) · Job Type: · Travel · Shift: · Night Shift · Dates: · 12/16/2024 to 03/17/2025 · Pay: · $2,007 - $2,230/week · Job Description: · About Gifted Healthcare: · Gifted Healthcare is an award-winning travel nursing agency that offers exceptional job ...
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Oral Surgeon
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Sonrava Health ModestoOverview · Are you an experienced Oral Surgeon looking for an exceptional opportunity? Sonrava Health is seeking a Board Eligible or Board-Certified Oral Surgeon to join our team in our Modesto, Stockton and Lodi, CA regions. At Sonrava Health, we are dedicated to providing a li ...
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Travel Nurse RN
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Host Healthcare ModestoJob Title: Registered Nurse - Emergency Room · Location: Modesto, CA · This role offers a unique opportunity to work in an exciting and fast-paced environment as a Registered Nurse in the Emergency Room department. You will be responsible for providing high-quality patient care, ...
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Travel Rad Tech in Modesto, CA
7 hours ago
Marvel Medical Staffing ModestoRad Tech Specialty Job Opportunity · We are seeking a highly skilled and dedicated Rad Tech specialist to join our team. As a key member of our medical imaging department, you will play a crucial role in ensuring high-quality patient care. · Job Summary · This 13-week contract po ...
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Travel Nurse RN
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Travel Nurse RN
6 hours ago
Gifted Healthcare ModestoJob Title: Registered Nurse (RN) · Duration: 12 weeks, 36 hours/week · Shift: Night Shift · The Gifted Healthcare Experience offers nursing contracts at premier healthcare facilities across the United States. Our mission is to help nurses thrive and advance their careers by provi ...
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Registered Nurse PICC
5 days ago
Anders Group, LLC ModestoRegistered Nurse PICC · Job Title: Registered Nurse - PICC Line Specialist · About the Job: · We are seeking a skilled Registered Nurse with experience in placing peripherally inserted central catheters (PICC lines) to join our team in Johnstown, PA. · Responsibilities: · - Place ...
Concurrent Review Nurse - Healthcare Specialist - Modesto - SAN JOAQUIN COUNTY HEALTH COMMISSION
Description
Job Title: Concurrent Review Nurse
We are seeking a skilled Nurse to join our team as a Concurrent Review Nurse. This role plays a crucial part in ensuring that members receive the most appropriate care, at the right time and place.
About the Role
This is an exciting opportunity for a dedicated healthcare professional to work in a fast-paced environment. As a Concurrent Review Nurse, you will be responsible for conducting onsite and/or telephonic reviews of inpatient activities, ensuring compliance with regulatory and contractual requirements.
Responsibilities
Requirements
To be successful in this role, you will need:
Preferred Qualifications
Candidates with experience in case management, utilization management, or discharge planning, as well as those familiar with managed care settings, Medi-Cal, and/or MediCare populations, will be highly valued.
What We Offer
As a Concurrent Review Nurse with us, you can expect:
About Us
We are SAN JOAQUIN COUNTY HEALTH COMMISSION, a mission-driven organization committed to improving the health of our community. Our values include diversity, equality, and respect for all individuals.
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Travel CT Technologist
Freelance Genie Healthcare- Modesto
-
Travel Electrophysiology Technician
Freelance LanceSoft- Modesto
-
Wound, Burn and Ostomy Physician
Advantage Surgical and Wound Care- Modesto
-
Travel Nurse RN
Freelance LanceSoft- Modesto
-
Travel Nurse RN
Freelance LanceSoft- Modesto, CA
-
Travel Cath Lab Technologist
Freelance Marvel Medical Staffing Allied- Modesto
-
Psychiatry - Geriatrics Physician
ProLocums- Modesto
-
Lead Neonatology Physician-North Central California
Integrity Healthcare- Modesto
-
Registered Nurse
Memorial Medical Center - AH- Modesto
-
Hand Surgeon Independent
Concentra- Modesto
-
Clinical Nurse Educator III, Birthing Center
Sutter Health- Modesto
-
Anesthesiology Physician
SUMO Medical Staffing- Modesto
-
Travel Nurse RN
Gifted Healthcare- Modesto
-
Psychiatric-Mental Health Physician
DocCafe- Modesto
-
Travel Nurse RN
Gifted Healthcare- Modesto
-
Oral Surgeon
Sonrava Health- Modesto
-
Travel Nurse RN
Host Healthcare- Modesto
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Travel Rad Tech in Modesto, CA
Marvel Medical Staffing- Modesto
-
Travel Nurse RN
Gifted Healthcare- Modesto
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Travel Nurse RN
Gifted Healthcare- Modesto
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Registered Nurse PICC
Anders Group, LLC- Modesto