Top 98 Quality improvement nurse Jobs in Bakersfield, Ca

UM Nurse Reviewer, LVN - Bakersfield 1.2
Universal Healthcare MSO LLC —Bakersfield, CA
- $31.00 - $54.18 an hour
- Full-time
- Nursing
- LVN
- RN License
- Health insurance
- Dental insurance
Clinical Review Specialist (Bakersfield)
Adventist Health —Bakersfield, CA
- $81,273 - $121,909 a year
- Day shift
- Nursing
- RN License
- Mid-level
PI and Patient Safety Specialist (Bakersfield)
Adventist Health —Bakersfield, CA
- $81,273 - $121,909 a year
- Day shift
- Nursing
- RN License
- Hospital
MDS Nurse Full-Time
Arvin Post Acute —Arvin, CA
- $72,000 - $100,000 a year
- Full-time
- Skilled nursing facility
- LVN
- RN License
- Paid training
- Health insurance
Quick Apply
3d
Health Center Nurse
OMNI FAMILY HEALTH —Bakersfield, CA
- $83,053 - $103,817 a year
- Weekends as needed
- Spanish
- CPR Certification
- Nursing
Quick Apply
PVMG-LVN
Integrated Practice Management LLC —Bakersfield, CA
- LVN
- Clinic experience
- Mid-level
Quick Apply
SUPERVISING REGISTERED NURSE II, CORRECTIONAL FACILITY
California Correctional Health Care Services —Kern County, CA
- $11,605 - $14,527 a month
- Full-time
- Current TB test
- RN License
- High school diploma or GED
7d
Licensed Vocational Nurse
DAVITA —Bakersfield, CA
- $26 - $38 an hour
- Weekends as needed
- Microsoft Word
- CPR Certification
- Microsoft Outlook
- Paid training
- Health insurance
6d
LVN Case Manager PHM- Bakersfield 1.1
Universal Healthcare MSO LLC —Bakersfield, CA
- $32.00 - $39.99 an hour
- Full-time
- Nursing
- Microsoft Excel
- LVN
- Paid holidays
- Health insurance
Patient Navigator
Heart Vascular and Leg Center —Bakersfield, CA
- From $21 an hour
- Full-time
- Mid-level
- 3 years
- Critical & Intensive Care
Quick Apply
UM Referral Coordinator I - Bakersfield 1.1
Universal Healthcare MSO LLC —Bakersfield, CA
- $20.96 - $26.19 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Office
- Paid holidays
- Health insurance
Health Center Manager
OMNI FAMILY HEALTH —Bakersfield, CA
- $72,434 - $90,543 a year
- Weekends as needed
- Spanish
- CPR Certification
- OSHA
Quick Apply
Registered Nurse - Mobile Clinic - Per Diem - Shift
Kern County Hospital Authority —Bakersfield, CA
- $41.05 - $64.68 an hour
- Part-time
- Acute care
- Background check
- Nursing
Quick Apply
Registered Nurse - Simulation Center - Full Time
Kern County Hospital Authority —Bakersfield, CA
- $43.51 - $68.56 an hour
- Part-time
- Acute care
- Background check
- Nursing
- Health insurance
- Paid time off
Quick Apply
10d
MEDICAL ASSISTANT
California Correctional Health Care Services —Kern County, CA
- $3,935 - $5,175 a month
- Full-time
- Current TB test
- Psychiatry
- Fingerprint clearance
- Referral program
Pharmacy Technician / Pharm Tech Apprenticeship
Walgreens —Bakersfield, CA
- $19.50 - $23.00 an hour
- Weekends as needed
- Computer literacy
- English
- Fair chance
- Health insurance
- Dental insurance
6d
Skilled Nurse - RN in Home Health
Guardian Angel Home Care Inc. —Bakersfield, CA
- $80,000 - $140,000 a year
- Part-time
- CPR Certification
- Nursing
- RN License
- Health insurance
- Dental insurance
Quick Apply
4d
Case Management Assistant, TCS (PHM)- Bakersfield 1.1
Universal Healthcare MSO LLC —Bakersfield, CA
- $21.31 - $26.63 an hour
- Full-time
- Microsoft Excel
- Mid-level
- 3 years
- Paid holidays
- Health insurance
RN Staff Nurse
Rehabilitation Center of Bakersfield —Bakersfield, CA
- $45 - $50 an hour
- Part-time
- CPR Certification
- Nursing
- RN License
Quick Apply
OBGYN Physician
MedConnect —Bakersfield, CA
- $360,000 - $421,000 a year
- Full-time
- BC/BE
- Ob/Gyn
- Senior level
- Relocation assistance
- Health insurance
Quick Apply

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UM Nurse Reviewer, LVN - Bakersfield 1.2

Universal Healthcare MSO LLC -
Bakersfield, CA

Apply Now

Job Details

Full-time
$31.00 - $54.18 an hour

Benefits

Health insurance
Dental insurance
Employee assistance program
Vision insurance
Life insurance

Qualifications

Collaborate with healthcare professionals
Patient follow-up care
Nursing
Medicare
LVN
Clinical program policy development
RN License
Managed care organization experience
Coaching
CMS
Coding for hospital billing
Patient demographics
Patient advocacy
Data reporting
Care documentation
Mid-level
Community resource coordination in health services social work
Technical support
Transitional care planning in clinical case management
CMS regulatory compliance
Healthcare referral management
Analysis skills
Policy & process development
Clinical data entry
Case review audits
Pre-authorization review for utilization management
Medicare regulations
InterQual
Case management
Utilization management

Full Job Description

Description:

Location: Bakersfield, CA 93309 (Onsite)

Classification: Full-Time

This position is non-exempt and will be paid on an hourly basis.

Schedule: Monday-Friday 8am-5pm

Benefits:

Medical
Dental
Vision
Simple IRA Plan with Employer Contribution
Employer Paid Life Insurance
Employee Assistance Program

Compensation: The initial pay range for this position upon commencement of employment is projected to fall between $31.00 and $38.74 for a California Licensed LVN & $43.35 and $54.18 for a California Licensed RN. However, the offered base pay may be subject to adjustments based on various individualized factors, such as the candidate's relevant knowledge, skills, and experience. We believe that exceptional talent deserves exceptional rewards. As a committed and forward-thinking organization, we offer competitive compensation packages designed to attract and retain top candidates like you.

Position Summary:

Under the guidance of the Utilization Management, the UM Nurse Reviewer will leverage expertise to conduct timely reviews of pre-certification and/or concurrent requests, aligning with established policies. The UM Nurse Reviewer holds responsibility for ensuring that members receive suitable care at the right time and location, all while adhering to federally and state regulated

turn-around times. This role involves reviewing services to guarantee the fulfillment of medical necessity, applying clinical knowledge to ensure proper benefit utilization, facilitating secure and efficient discharge planning, and collaborating closely with internal and external stakeholders to address the multifaceted needs of the member.

Requirements:

Job Duties and Responsibilities:

Performs utilization review activities, including pre-certification, concurrent, and/or retrospective reviews according to regulatory guidelines.
Reviews proposed hospitalization, home care, and inpatient / outpatient treatment plans for medical necessity and efficiency in accordance with CMS coverage guidelines.
Determines medical necessity of each request by applying appropriate medical criteria to designated level reviews and utilize approved evidenced-based guidelines or criteria.
Utilizes considerable clinical judgement, independent analysis, critical-thinking skills and detailed knowledge of medical policies, clinical guidelines, and benefit plans to complete reviews and determinations within required turnaround times specific to the case type.
Answers Utilization Management directed telephone calls, managing them in a professional and competent manner.
Refers case to Medical Reviewer when the request does not meet medical necessity per guidelines, or when guidelines are not available.
Reviews, documents, and communicates all utilization review activities and outcomes including, but not limited to, all calls made and received in regard to case communication and all demographic and service group information.
Sends appropriate system-generated letters to providers and members.
May provide guidance and coaching to other UM nurses and participate in the orientation of newly hired staff.
Identifies and refers all potential quality issues to the Clinical Quality Management Department, and suspected fraud and abuse cases to Compliance Department.
Identify and refer potential cases to Disease Management and Case Management Team.
For concurrent referrals, ensure that all post-discharge care is coordinated appropriately according to the needs of the member and ensures appropriate continuity of care.
Participates in Patient-Centered quality improvement initiatives.
Participates in monthly/quarterly and annual audits.
Maintain knowledge of DOFR (Disposition of Financial Responsibility), Medicare guidelines, MCG, InterQual, health plan guidelines, and other necessary UM resources.
Assist in developing workflows, job aid, standard operating procedures, and/or policies and recommend or change as appropriate to ensure timely, efficient, and effective outputs including NCQA, CMS, and other regulatory agencies.
Participates in data collection, health outcome reporting, clinical audits, and programmatic evaluations.
Supports patient care database by entering new information as it becomes available, verifying findings and backing-up data.
Track and trend patient care logs for all required health plans, as needed.
Ensures clinical documentation is thorough and includes information on transition of care needs of members transitioning from one level of care to another.
Works with the other support team personnel in a collaborative professional manner to best service the company.
Identifies high-risk members and conduct necessary interventions, which may include immediate follow-up with Primary Care Physician, community resources such as transportation assistance or programs such as Meals on Wheels for dietary support.
Presents member cases during Multidisciplinary Rounds to provide update and recommendations on member care status and needs to facilitate safe discharges and prevent avoidable delays during admissions.
Facilitates access to necessary care by navigating barriers and advocating for members,

educating members and families/caregivers on the transition process, options for post-acute care and level set expectations while setting achievable, safe goals.

Provides technical support and serves as resource to PCP and specialists offices, providers, and members regarding healthcare needs and authorization process.
Performs all other related duties as assigned.

Qualifications

Active Unrestricted Current California RN or LVN license
At least one year of managed care experience with prior experience in ambulatory case management, utilization management, disease management or any combination of education/ experience preferred.
Proficient in PC Software computer skills
ICD-10, CPT coding knowledge/experience preferred.
Medicare guidelines, InterQual, or MCG knowledge/experience preferred.
Excellent communication skills both verbal and written skills
Solid problem solving and analytical skills.
Ability to interact productively with individuals and with multidisciplinary teams with minimal guidance.
Possess planning, organizing, conflict resolution, negotiating, and essential interpersonal skills.

Apply Now

Refine Your Search

quality improvement nurse jobs in bakersfield, ca

UM Nurse Reviewer, LVN - Bakersfield 1.2

Clinical Review Specialist (Bakersfield)

PI and Patient Safety Specialist (Bakersfield)

MDS Nurse Full-Time

Health Center Nurse

PVMG-LVN

SUPERVISING REGISTERED NURSE II, CORRECTIONAL FACILITY

Licensed Vocational Nurse

LVN Case Manager PHM- Bakersfield 1.1

Patient Navigator

UM Referral Coordinator I - Bakersfield 1.1

Health Center Manager

Registered Nurse - Mobile Clinic - Per Diem - Shift

Registered Nurse - Simulation Center - Full Time

MEDICAL ASSISTANT

Pharmacy Technician / Pharm Tech Apprenticeship

Skilled Nurse - RN in Home Health

Case Management Assistant, TCS (PHM)- Bakersfield 1.1

RN Staff Nurse

OBGYN Physician

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