Description Clinical Program Coordinator RN in Quality Assurance Unit at Queen of the Valley Medical Center, CA. This position is Full time and will work 8-hour Day Shifts.. Providence Queen of the Valley Medical Center is committed to delivering top-notch healthcare, earning recognition from U.S. News & World Report as a High-Performance Hospital for heart attack, heart & kidney failure, hip fracture, stroke, and maternity care.. The Coordinator is accountable for the overall management, leadership, and direction of the clinical and operational activities of the Sepsis program in accordance with Providence Queen of the Valley Medical Center's Mission and Core Values.. Join our team at Queen Of The Valley Medical Ctr and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect.. 3 years of Inpatient clinical nursing practice or 2 years of Inpatient clinical nursing practice if candidate possesses a Master of Science in Nursing (MSN) with specialty training as a Clinical Nurse Specialist (CNS), Clinical Nurse Leader (CNL), or Nursing Education.
In this role you will perform accurate and timely clinical review of post service claims focused primarily on Behavioral Health outpatient services, Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP).. The successful RN candidate will review outpatient post service cases for benefits, medical necessity, coding accuracy and medical policy compliance.. Prepare and present cases to Medical Director (MD) for medical director oversight and necessity determination and communicate determinations to providers and/or members to in compliance with state, federal and accreditation requirements Perform retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare. Conducts clinical review of claims for medical necessity, coding accuracy, and medical policy compliance. Knowledge of CPT-4, ICD-9, HCPCs, with 1-2 years' experience in coding.
Gifted Healthcare is an award-winning travel nursing agency that offers nursing contracts at premier healthcare facilities across the United States.. Gifted Healthcare believes in the power one person has to make a difference in a patient's care, inspiring Gifted's mission to help nurses thrive and advance their careers by providing exceptional job opportunities , day one benefits , and 24/7 support.. Premium Overtime - You will receive 2x your hourly rate on travel assignments for all overtime hours worked (excluding local, PRN, CA, Govt assignments).. 24/7 support with Career Specialist. Access to Chief Nursing Officer 24/7
The Nurse Manager works closely and collaboratively with the practice managers within a dyad model, providing clinical oversight and supervision for nurses.. Supervise and mentor a team of RNs and LVNs.. Manage specialized program areas such as Quality Improvement, Utilization Management, Infection Control, or Epidemiology, as required.. Experience working in an FQHC or similar healthcare setting.. Demonstrated person-centered approach and familiarity with trauma-informed systems and restorative practices