What are the responsibilities and job description for the Care Review Clinician II - Waste Fraud Abuse (67521-1) position at Professional Management Enterprises?
Care Review Clinician I(RN) to work daily with CA hospitals, SNF's, and other care entities to discharge CA Health Plan members safely to a reduce level of care. This position is FULLY remote but will require minimal travel within CA (i.e. Laboratory equipment validation).
- MUST be a licensed RN in the state of CA . The work schedule will be M-F 8 : 00am-5 : 00pm PST.
KNOWLEDGE / SKILLS / ABILITIES
Work with Corporate Special Investigations Unit (SIU) to perform work on behalf of the CA Health Plan.
Review CLIA certification documentation from laboratories, contacting laboratories and California members.
Review fraud, waste, and abuse inquiries on behalf of the CA Health Plan.
Must Have Skills :
CA Registered Nurse with strong background in Fraud Waste and Abuse
Hospice experience preferred
Case Management experience preferred
Required Education
Nursing Degree
Required License
Licensure required is a CA State License Registered Nurse - RN license
