What are the responsibilities and job description for the Care Review Clinician II position at Careers Integrated Resources Inc?
Job Description:
Temp to hire role for *** of California, however, reporting into MHI SIU
This is a remote position, and an exception has been provided that this candidate needs to be licensed in CA RN AND reside in Southern California
M-F 8-5 PM PST
Job Description:
Seeking a CA licensed and CA based (Southern California preferred) Registered Nurse (RN) with a strong background in fraud waste and abuse, to work with MHI SIU on behalf of *** of CA.
RN will review CLIA certification documentation from non-participating laboratories.
RN may contact the non-participating labs as well as *** of California members.
RN will report to SIU leadership on suspected fraud as well as report on non-par labs that have provided appropriate documentation.
RN may travel to non-par laboratory locations to inspect that proper equipment exists. RN will also assist with other *** of CA referrals to SIU.
Must Have Skills:
CA Registered Nurse with strong background in Fraud Waste and Abuse
Hospice experience preferred
Case Management experience preferred
Day to Day Responsibilities:
RN will be working within our Corporate Special Investigations Unit (SIU) to perform work on behalf of the CA Health Plan.
The RN will be reviewing CLIA certification documentation from laboratories, contacting laboratories and Client of California members.
The RN will also review fraud, waste, and abuse inquiries on behalf of the CA Health Plan.
This role is primarily remote, however, travel within CA will be necessary (i.e. Laboratory equipment validation). -we don't have an estimation of distance and how often they will need to travel. They may have to conduct onsite investigations for certain labs and hospice providers, and we service a number of counties. We would expect them to conduct at least a few onsites per year
Required Years of Experience:
5 years of clinical experience preferred
Required Licensure / Education:
CA licensed RN, Located in CA (Southern California preferred)
Comments for Suppliers: no additional monitors or docking station needed
Temp to hire role for *** of California, however, reporting into MHI SIU
This is a remote position, and an exception has been provided that this candidate needs to be licensed in CA RN AND reside in Southern California
M-F 8-5 PM PST
Job Description:
Seeking a CA licensed and CA based (Southern California preferred) Registered Nurse (RN) with a strong background in fraud waste and abuse, to work with MHI SIU on behalf of *** of CA.
RN will review CLIA certification documentation from non-participating laboratories.
RN may contact the non-participating labs as well as *** of California members.
RN will report to SIU leadership on suspected fraud as well as report on non-par labs that have provided appropriate documentation.
RN may travel to non-par laboratory locations to inspect that proper equipment exists. RN will also assist with other *** of CA referrals to SIU.
Must Have Skills:
CA Registered Nurse with strong background in Fraud Waste and Abuse
Hospice experience preferred
Case Management experience preferred
Day to Day Responsibilities:
RN will be working within our Corporate Special Investigations Unit (SIU) to perform work on behalf of the CA Health Plan.
The RN will be reviewing CLIA certification documentation from laboratories, contacting laboratories and Client of California members.
The RN will also review fraud, waste, and abuse inquiries on behalf of the CA Health Plan.
This role is primarily remote, however, travel within CA will be necessary (i.e. Laboratory equipment validation). -we don't have an estimation of distance and how often they will need to travel. They may have to conduct onsite investigations for certain labs and hospice providers, and we service a number of counties. We would expect them to conduct at least a few onsites per year
Required Years of Experience:
5 years of clinical experience preferred
Required Licensure / Education:
CA licensed RN, Located in CA (Southern California preferred)
Comments for Suppliers: no additional monitors or docking station needed
