RN Case Manager Full Time La Palma, CA $10,000 Sign On Bonus External Candidates This position provides daily operational direction to the Inpatient Services Department including oversight and supervision of Inpatient Case Managers. Manages exempt and non exempt employees. Works collaboratively with the Medical Director for Inpatient Services and Acute and Post Acute Serv

Supports the Care team and its patients through patient care, clinical and administrative tasks including patient intake, receiving and responding to patient phone calls, and documenting patient interactions Performs duties within their scope of practice delegated by, and under the supervision of, a provider or physician Performs all duties within the scope of a Medical A

Interpret contracts to create billing and revenue rules within the PeopleSoft ERP (PS ERP) Review, analyze and validate billing data Generate and validate Invoices Work with Project Managers/Operations/Finance to ensure accuracy Work with Cash Applications/Accounting Problem solving Responsible for effectively researching, tracking and resolving billing problems and discr

Create new consumer experiences focused on patients, providers, payers, and others across the health care ecosystem Design new approaches that enhance and extend the consumer experiences Gather consumer and end user requirements through in person interviews and secondary research Help clients empathize with users by creating deliverables that tell a compelling story Serve

Assisting broadly with deal execution, including deal positioning and valuation, thinking beyond Optum and UHC business units to develop UHG level enterprise strategy and solutions Liaising with external partner program managers and internal business units, facilitating joint working group activities with cross functional clinical, strategy, finance, and legal teams Devel

Create new consumer experiences focused on patients, providers, payers, and others across the healthcare ecosystem Design new approaches that enhance and extend consumer experiences Gather consumer and end user requirements through in person interviews and secondary research Help clients empathize with users by creating deliverables that tell a compelling story Serve as a

Oversees and coordinates due diligence efforts for acquisition targets Directs the strategic planning and management of the integration projects and team to ensure that the goals and objectives are accomplished within the prescribed time frame Directs the project management and process improvement activities to achieve optimal implementation and control outcomes Identifie

Provides medical care and management to members served by the program and participates in gathering clinical information for medical necessity determinations for service requests. Works with the Landmark Health Medical Director, Director of Health Services, Corporate Director of Health Services, and UM staff in the development and/or implementation of medical management p

Provides medical care and management to members served by the program and participates in gathering clinical information for medical necessity determinations for service requests. Works with the Landmark Health Medical Director, Director of Health Services, Corporate Director of Health Services, and UM staff in the development and/or implementation of medical management p

Develops, perform and manage the analyses of the Global business, financial metrics and performance measures Owns membership reporting and source of truth for the Global business Performs analysis and clearly communicates actual results, forecasted performance, and variances to plan, forecast and budget in relation to productivity, membership, medical trends, premium yiel

Conduct in home assessments on health plan members. Average visit is 45 60 minutes in length. Assessment is performed and completed electronically. HouseCalls Assessment includes Past medical history Review of systems Medication review Evidence based practice screenings Checking vitals, conducting a physical exam that includes point of care testing (as appropriate) Identi

Practices in accordance with the respective state laws and regulations governing the practice of advanced practice nursing Understands and complies with long term care policies and procedures, including those that regulate nursing facilities and assisted living communities Establishes and maintains effective relationships with members and their legal representatives, faci

Collects laboratory specimens from patients of all ages Processes laboratory specimens according to protocol Demonstrates appropriate telephone etiquette Utilizes computer information systems Adheres to organization and governmental standards, rules and regulations Performs clerical duties Promotes good customer service Prioritizes workload to efficiently provide Provider

Architect and develop scalable authorization and eligibility solutions for both web and mobile applications Participate in the full software development lifecycle, including development, code reviews, testing and monitoring Develop APIs and microservices primarily in Scala Build scalable systems, libraries, and frameworks Develop database models using appropriate database

Develop business data transformation to support operational, product, customer, and reporting development efforts Develop product analytic transformed population data sets that drive business insights Develop data verification, quality methods and standard systems procedures that will be used to support Business Intelligence Platforms Develop BI driven metrics, aggregatio