UNKNOWN

ADAPTED_NOW

HOUR

Experience with Appeals & Grievances, Utilization Management, Medical Management, Quality Improvement, Healthcare Compliance, Clinical Audits, Regulatory Audits, HEDIS, NCQA, Medi-Cal, or related managed care programs preferred. Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal.

Jobot is on a mission to connect good people with good jobs. By combining AI-powered technology with the expertise of Jobot Pros, our experienced recruiters, we help you find career opportunities that align with your goals and values.
Founded in 2018 and employee-owned since 2024, Jobot is committed to fostering a culture of kindness, respect, innovation, and connection.  As an industry leader, we’ve been recognized as a top workplace by Forbes, Fortune, USA Today, and Staffing Industry Analysts (SIA).
Ready to find a good job? Create your profile today at Jobot.com 🤖

Jobot

Medical Management Nurse Analyst

Assess and interpret medical and psycho-social histories; perform physical examinations (including gynecological and breast examination as appropriate; identify problems; formulate a plan of treatment; provide education and referral (as indicated); and evaluate the effectiveness of the interventions prescribed. Refer patient to other available services/specialist to meet needs where appropriate Examine patients, formulate differential diagnostic plans, and define and order required diagnostic testing.

YEAR

DAP Health

Certified Nurse Midwife

One Red Cent - Marketplace

Assess and interpret medical and psycho-social histories; perform physical examinations (including gynecological and breast examination as appropriate; identify problems; formulate a plan of treatment; provide education and referral (as indicated); and evaluate the effectiveness of the interventions prescribed. As a leading nonprofit health care provider, we deliver compassionate, high-quality care to the diverse communities of the Coachella Valley and San Diego County.

Float Advanced Practice Provider (NP/PA)

Assess and interpret medical and psycho-social histories; perform physical examinations (including gynecological and breast examination as appropriate; identify problems; formulate a plan of treatment; provide education and referral (as indicated); and evaluate the effectiveness of the interventions prescribed. The HIV Primary Care Advanced Practice Provider works to support the mission and vision of DAP Health by providing excellent patient-centered care and services within a dynamic team environment.

HIV Primary Care Advanced Practice Provider (NP/PA)

Per Diem Advanced Practice Clinician (NP/PA)

Urgent Care Advanced Practice Provider (NP/PA)

Primary Care Advanced Practice Provider (NP/PA)

Contributes to DAP's Patient Centered Medical Home (PCMH) program, a model of primary care delivery designed to strengthen the patient/clinician relationship, focus on the person and patient self-management and engagement, by providing comprehensive and coordinated care in a culturally and linguistically sensitive manner. Practices medicine; diagnoses and treats illness and injury; performs minor surgery and completes physical examinations; counsels and instructs patients; provides professional supervision of mid-level providers; instructs and educates trainees and/or staff; assists in public relations efforts.

Part-Time Primary Care Physician

Internal Medicine Physician

Practices medicine; provides prenatal, intra-partum and post-partum and gynecological medical care; diagnoses and treats disorders of the female reproductive system; initiates referrals to specialists as medically indicate; share oversight of the inpatient OB management and care provided by NPs and CNMs; shares in Labor & Delivery coverage and OB/GYN call rotation; counsels and instructs patients; instructs and educates trainees and/or staff; assists in public relations efforts. Contributes to DAP's Patient Centered Medical Home (PCMH) program, a model of primary care delivery designed to strengthen the patient/clinician relationship, focus on the person and patient self-management and engagement, by providing comprehensive and coordinated care in a culturally and linguistically sensitive manner.

Per Diem OB/GYN Physician

FEED

However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models.

SCAN Health Plan

HEDIS Nurse - SCAN Temp

linkup_via_bold

SCAN Healthplan

Hedis Nurse - Scan Temp

ea_via_bold

For more information on Palmdale Regional, please visit www.palmdaleregional.com and follow Palmdale Regional Medical Center on social: Facebook, Instagram, LinkedIn and YouTube One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance, growing since its inception into a Fortune 500 corporation. www.swhpalmdaleregional.com/careers Position Description: Works with clinical, site level quality and other appropriate staff to assist with timely and accurate clinical data submission and developing strategies and corrective actions to enhance continuous compliance with measures.

University Health Services Inc

Quality Improvement Abstractor-HEDIS

For more information on Palmdale Regional, please visit www.palmdaleregional.com and follow Palmdale Regional Medical Center on social: Facebook, Instagram, LinkedIn and YouTube Position Description: The Clinical Effective Nurse - Abstractor will analyze and report on key clinical performance measures (Stroke & Sepsis) by identifying and accessing relevant data sources, aggregating and manipulating data as needed, preparing graphs and tables from data, ensuring the integrity and accuracy of data and reported measures, and submitting information to CMS and other agencies as requested. Through its subsidiaries, UHS operates inpatient acute care facilities, inpatient behavioral health facilities, outpatient and other facilities, nationwide virtual behavioral health services, an insurance offering, a physician network and various related services with physical locations in the U.S., Puerto Rico, Ireland and United Kingdom.

Quality Improvement Abstractor- HEDIS

However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. Perform audits/reviews of medical claims per established criteria, identify need for medical record review, necessary documentation to support decision making process regarding appropriateness of claim, billed charges, benefit coverages.

Medical Review Nurse

sourcestack_via_bold

Must be able to independently work within Microsoft Office products including Word, Excel, PPT, to Include creating/saving documents in folders, setting up and utilizing spreadsheets, copying and pasting data from one document to another. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country.

Machinify

Medical Review Nurse II - SNF/MDS Auditor

Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country.

Medical Review Nurse - CMS/RAC Auditor, Government Audits

Care Coordination & Patient Management Ensure continuity of care through follow-up visits, chart review, and care coordination. Support preventative care programs such as Annual Wellness Visits (AWVs) and chronic disease management.

Talent Connect Now

Nurse Practitioner (NP)

Reporting to the Supervisor, Non-Routine Placement, this role works closely with hospitals, Independent Physician Associations (IPAs), Skilled Nursing Facilities (SNFs), Congregate Living Health Facilities (CLHFs), and other post-acute providers to ensure timely, cost-effective, and high-quality care transitions. The Non-Routine Placement Nurse collaborates with transitional care management, discharge planning, and readmission prevention teams to oversee complex cases, maintain regulatory compliance, and support optimal patient outcomes.

Impresiv Health

Non-Routine Placement Nurse, RN

jobdiva

OTHER

This role partners closely with hospitals, Independent Physician Associations (IPAs), skilled nursing facilities (SNFs), congregate living health facilities (CLHFs), and other post-acute providers to ensure timely, cost-effective, and high-quality care transitions. Partner with case managers, social workers, providers, hospitals, IPAs, and post-acute partners using critical thinking to identify appropriate care pathways and resolve placement barriers.

Hedis Review Nurse Jobs in California

Medical Management Nurse Analyst Jobot

Certified Nurse Midwife DAP Health

Float Advanced Practice Provider (NP/PA) DAP Health

HIV Primary Care Advanced Practice Provider (NP/PA) DAP Health

Per Diem Advanced Practice Clinician (NP/PA) DAP Health

Urgent Care Advanced Practice Provider (NP/PA) DAP Health

Primary Care Advanced Practice Provider (NP/PA) DAP Health

Part-Time Primary Care Physician DAP Health

Internal Medicine Physician DAP Health

Per Diem OB/GYN Physician DAP Health

HEDIS Nurse - SCAN Temp SCAN Health Plan

Hedis Nurse - Scan Temp SCAN Healthplan

Quality Improvement Abstractor-HEDIS University Health Services Inc

Quality Improvement Abstractor- HEDIS University Health Services Inc

Medical Review Nurse SCAN Health Plan

Medical Review Nurse II - SNF/MDS Auditor Machinify

Medical Review Nurse - CMS/RAC Auditor, Government Audits Machinify

Nurse Practitioner (NP) Talent Connect Now

Non-Routine Placement Nurse, RN Impresiv Health

Non-Routine Placement Nurse, RN (Short-Term Assignment) Inland Empire Health Plan

Similar Job Searches

Stand out to leading employers.