Quality Management Nurse
5.
0 Hemet, CA Hemet, CA Full-time Full-time $28 - $35 an hour $28 - $35 an hour 2 days ago 2 days ago 2 days ago Essential Job Functions:
Processes all appeals:
Determines benefits Obtains supporting documentation Answers Health Plan with determination Processes all complaints/grievances:
Reviews and determines nature of complaint Requests information from party complaint is regarding Introduces complaint to QM Committee for determination Provides response back to Health Plan Prepares required reports:
QM evaluation (evaluation of previous year's work accomplished) Quarterly reports Logs appeals and complaints quarterly per Health Plan Audits (only as needed with Compliance Manager):
Access Audits Medical Record Audits Focus Audit Determines number of charts to audit per provider Prepares documentation for Health Plan proposal Prepares finding of audit and distributes to Health Plans Note:
This job description is not intended to be all-inclusive.
The employee may perform other related duties as negotiated to meet the ongoing needs of the organization.
Job Type:
Full-time Pay:
$28.
00 - $35.
00 per hour Expected hours:
40 per week
Benefits:
401(k) Dental insurance Health insurance Life insurance Paid time off Vision insurance Schedule:
Monday to Friday Work Location:
In person.
Estimated Salary: $20 to $28 per hour based on qualifications.
0 Hemet, CA Hemet, CA Full-time Full-time $28 - $35 an hour $28 - $35 an hour 2 days ago 2 days ago 2 days ago Essential Job Functions:
Processes all appeals:
Determines benefits Obtains supporting documentation Answers Health Plan with determination Processes all complaints/grievances:
Reviews and determines nature of complaint Requests information from party complaint is regarding Introduces complaint to QM Committee for determination Provides response back to Health Plan Prepares required reports:
QM evaluation (evaluation of previous year's work accomplished) Quarterly reports Logs appeals and complaints quarterly per Health Plan Audits (only as needed with Compliance Manager):
Access Audits Medical Record Audits Focus Audit Determines number of charts to audit per provider Prepares documentation for Health Plan proposal Prepares finding of audit and distributes to Health Plans Note:
This job description is not intended to be all-inclusive.
The employee may perform other related duties as negotiated to meet the ongoing needs of the organization.
Job Type:
Full-time Pay:
$28.
00 - $35.
00 per hour Expected hours:
40 per week
Benefits:
401(k) Dental insurance Health insurance Life insurance Paid time off Vision insurance Schedule:
Monday to Friday Work Location:
In person.
Estimated Salary: $20 to $28 per hour based on qualifications.
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