Firstsource Advantage Reviews Jobs in Usa

9,903 positions found

Physician / Family Practice / Florida / Permanent / Medicare Advantage Primary Care Job
$245,000
Chicago, Illinois 4 days ago
Primary Care Physician Outpatient Senior-Focused Florida, Alabama, Oklahoma (Multiple Locations) 100% Outpatient Primary Care for Seniors Medicare Advantage / Value-Based Model No Hospital Rounds No Nights No Weekends Excellent Work-Life Balance Practice Highlights Unmatched Work-Life Balance : Low daily volume (typically 1015 patients) with extended visit times focused on prevention, chronic care management, and strong patient relationships.

Value-Based Senior Care Model : Smaller panels prioritize quality outcomes, preventive health, and better health for Medicare Advantage and senior patients.

Modern, Supportive Clinics : State-of-the-art facilities with dedicated clinical teams (MAs, scribes, care coordinators) and robust referral networks for efficient, rewarding practice.

Collaborative Team Environment : Join mission-driven teams dedicated to senior wellness and value-based excellence across FL, AL, and OK locations.

Compensation & Benefits Competitive Base Salary : $245,000 $260,000+ (negotiable based on experience and location) Performance Incentives : Generous quality and value-based bonuses ( $100,000 annually) Sign-On & Relocation : Available bonuses and assistance Time Off & Professional Support : 4 weeks (160 hours) PTO + 8 paid holidays (no waiting period); up to $1,500 annual CME reimbursement + licensing fees covered Full Benefits Package : Medical, dental, vision, disability, life insurance; 401(k) with employer match + dedicated financial advisor; malpractice with tail coverage; wellness program, EAP, and more Candidate Qualifications MD or DO Board Certified/Eligible in Family Medicine, Internal Medicine, or Geriatric Medicine Active (or eligible for) state medical license in FL, AL, or OK DEA license and current CPR (BLS/ACLS/PALS) Passion for senior/geriatric care, preventive medicine, and value-based models Bilingual (English/Spanish) a plus in select locations About the Communities Opportunities in Florida, Alabama, and Oklahoma Practice in desirable locations across three states, offering varied lifestyles with strong appeal for physicians and families.

Florida Locations : Year-round warm weather, no state income tax, lower cost of living than major metros, world-class beaches, golf, fishing, theme parks, international airports, top schools, and vibrant coastal/suburban communities.

Alabama Locations : Affordable Southern living, beautiful neighborhoods, family-friendly vibe, abundant outdoor recreation (parks, trails, equestrian activities), welcoming communities, and easy access to major highways/airports.

Oklahoma Locations : Low cost of living, safe family-oriented areas, excellent schools/universities, outdoor activities, and a relaxed pace with strong community support.

This multi-state outpatient primary care physician opportunity delivers outstanding compensation, superior work-life balance (no call, no hospital duties), value-based senior-focused care, and flexible location choices in FL, AL, or OKideal for Family Medicine, Internal Medicine, or Geriatric physicians passionate about Medicare Advantage, prevention, and meaningful senior health outcomes.

Interested in this primary care physician job Florida , senior-focused PCP Alabama , value-based primary care Oklahoma , outpatient geriatric medicine multi-state , or similar roles? Apply today reference FP 26145
permanent
Family Medicine Physician - Medicare Advantage Clinic
✦ New
$285,000 - 305,000
Loma Linda, CA 1 day ago

Loma Linda University Faculty Medical Group, Department of Family Medicine, has an immediate need for a Physician to join our team. The ideal candidate will be passionate about a position in a collegial, faith-based environment.

The ideal candidate will be a Board Certified Family Physician with primary care experience. We are looking for a physician with strong interpersonal skills, excited to develop a relationship with each patient, and work with them on an individual plan to improve their health and wellness. This Physician will be primarily based in Loma Linda at the Professional Plaza in the Loma Linda Advantage Clinic, a Medicare Advantage, value based care model where our team of dedicated physicians and APPs provide patient-centered care, to manage chronic conditions in our population of older adults.

Loma Linda University Faculty Medical Group is affiliated with Loma Linda University Medical Center, Children’s Hospital and School of Medicine, with the mission to deliver whole-person care at a world-class level of clinical excellence. The Medical Center serves as the largest tertiary referral source in both Riverside and San Bernardino counties with a surrounding population approaching 4 million.

For over 100 years, Loma Linda University Health has been dedicated to excellence in health care, research, and education. We have expanded our children’s hospital to continue meeting the health needs of our community by building new state-of-the-art towers allowing for the newest advances in technology and patient care. We have also expanded and enhanced our already robust research enterprise through a new collaborative research center and program endowment.

Loma Linda University Health continues to lead in integrating a faith-based approach to whole person health care. As a Seventh-day Adventist organization, our mission is to follow the healing and teaching ministry of Jesus Christ 'to make man whole.' Together, we strive for Compassion, Integrity, Excellence, Teamwork, and Wholeness.

About the area

Loma Linda, recognized as the only Blue Zone in the nation, is a family-friendly community known for its strong sense of community and commitment to health and wellness. Loma Linda University is located in Southern California between Los Angeles and Palm Springs in an area known as the Inland Empire. Nestled at the foot of the San Bernardino mountains, we have convenient access to beaches, skiing, hiking, and a variety of other outdoor activities. This growing region has a low cost of living and excellent private and public school systems. Faculty members are eligible for federal student loan forgiveness programs.

Compensation & Benefits

The compensation range listed is for starting base compensation only and is adjusted based upon years of experience and/or faculty rank: $285,000- $305,000. This amount does not include variable compensation or extra productivity and is subject to the individual department compensation plans. More information on compensation is discussed with the departments during the recruitment process.

Our benefits include:

  • Generous Retirement Contribution
  • Comprehensive Medical/Dental Coverage
  • Competitive Vacation & Sick Days
  • CME Days and Funds
  • Relocation Assistance (if applicable)
  • Paid Malpractice Insurance
  • Paid Life Insurance
  • Loan Repayment/State & Federal (If eligible)

For more information on Loan Forgiveness, please click on the links below:

We are a California Employer - Please note that a California residency is required upon start date.

This opportunity is not eligible for a Conrad 30 Waiver.

Not Specified
Care Coordinator - Focus on Medicare Advantage enhancement and interdisciplinary treatment coordination. (HONDO)
Salary not disclosed
HONDO, Texas 4 days ago
POSITION SUMMARY/RESPONSIBILITIES

Care Coordinator will be instrumental in assisting the department and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary. Will monitor opportunities within the Medicare managed group to enhance financial outcomes. Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum. Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs. Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve patient outcomes, compliance, and decrease complications.

EDUCATION/EXPERIENCE

Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred. Three years recent, full time hospital experience preferred. Work experience in case management, utilization review, or hospital quality assurance experience is preferred.

LICENSURE/CERTIFICATION

Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required. National certification in related field is desirable. Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse Educator certification is highly desirable. Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.
permanent
Care Coordinator - Optimize Medicare Advantage outcomes through interdisciplinary coordination. (BOERNE)
🏢 University Health
Salary not disclosed
BOERNE, Texas 4 days ago
POSITION SUMMARY/RESPONSIBILITIES

Care Coordinator will be instrumental in assisting the department and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary. Will monitor opportunities within the Medicare managed group to enhance financial outcomes. Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum. Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs. Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve patient outcomes, compliance, and decrease complications.

EDUCATION/EXPERIENCE

Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred. Three years recent, full time hospital experience preferred. Work experience in case management, utilization review, or hospital quality assurance experience is preferred.

LICENSURE/CERTIFICATION

Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required. National certification in related field is desirable. Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse Educator certification is highly desirable. Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.
permanent
Utilization Review Nurse Health Plans-Hp Utilization Mgmt
✦ New
Salary not disclosed
Irving, TX 1 day ago
Description

Summary:

The Utilization Review Nurse is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This nurse is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services “CMS” Inpatient List). They effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and guidelines related to UM. This nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services. The Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS.

Responsibilities:

  • Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
  • The prior authorization role completes an assessment of a proposed service to determine if the beneficiary has eligible coverage for the service and if it is medically necessary.
  • Promote quality, cost-effective outcomes through prior authorization and concurrent review of requested services for medical necessity based upon evidence-based clinical guidelines.
  • Identify and present cases of possible quality of care deviations, questionable admissions, and prolonged lengths of stay to the Medical Director for further determination.
  • Appropriately refer beneficiaries who have complex or chronic conditions, a need for transition of care, disease management support, or other identifiable needs for coordination of the beneficiary’s member’s health care for behavioral health care management.
  • Follow CHRISTUS Health Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent, or detect unauthorized disclosure of Protected Health Information (PHI).
  • Protect the confidentiality of data and intellectual property;
    assures compliance withnational health information guidelines.
  • Analyze clinical information submitted by medical providers to evaluate the medical necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities.
  • Perform provider outreach to address post-hospital discharge services, redirection to in-network providers for appropriate steerage, durable equipment usage, and utilization of other medical services and/or procedures and other necessary telephonic follow-up.
  • Utilize the nursing process and critical thinking skills to provide oversight of services and evaluation of service options.
  • Ability to work in a variety of settings with culturally diverse communities with the ability to be culturally sensitive and appropriate.
  • Must have excellent communication skills (written and verbal), clinical judgment, initiative, critical thinking, and problem-solving abilities.
  • Must be able to take after hour calls to meet business requirements as needed.

Job Requirements:

Education/Skills

  • Graduate of an accredited school of vocational nursing or equivalent required
  • Associate’s (ADN) or Bachelor’s (BSN) in Nursing preferred

Experience

  • 3 – 5 years of nursing experience preferred
  • Experience in Microsoft software (e.G., Outlook, Teams, Word, and Excel) required
  • General computer knowledge and capability to use computers required

Licenses, Registrations, or Certifications

  • LVN license in the state of employment or compact required
  • RN license in state of employment or compact preferred

Work Schedule:

5 Days - 8 Hours

Work Type:

Full Time

Not Specified
Utilization Review Nurse Health Plans-HP Utilization Mgmt (Hiring Immediately)
🏢 Christus Health
Salary not disclosed
Irving, TX 6 days ago
Description

Summary:

The Utilization Review Nurse is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This nurse is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services “CMS” Inpatient List). They effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and guidelines related to UM. This nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services. The Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS.

Responsibilities:

  • Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
  • The prior authorization role completes an assessment of a proposed service to determine if the beneficiary has eligible coverage for the service and if it is medically necessary.
  • Promote quality, cost-effective outcomes through prior authorization and concurrent review of requested services for medical necessity based upon evidence-based clinical guidelines.
  • Identify and present cases of possible quality of care deviations, questionable admissions, and prolonged lengths of stay to the Medical Director for further determination.
  • Appropriately refer beneficiaries who have complex or chronic conditions, a need for transition of care, disease management support, or other identifiable needs for coordination of the beneficiary’s member’s health care for behavioral health care management.
  • Follow CHRISTUS Health Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent, or detect unauthorized disclosure of Protected Health Information (PHI).
  • Protect the confidentiality of data and intellectual property; assures compliance with national health information guidelines.
  • Analyze clinical information submitted by medical providers to evaluate the medical necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities.
  • Perform provider outreach to address post-hospital discharge services, redirection to in-network providers for appropriate steerage, durable equipment usage, and utilization of other medical services and/or procedures and other necessary telephonic follow-up.
  • Utilize the nursing process and critical thinking skills to provide oversight of services and evaluation of service options.
  • Ability to work in a variety of settings with culturally diverse communities with the ability to be culturally sensitive and appropriate. 
  • Must have excellent communication skills (written and verbal), clinical judgment, initiative, critical thinking, and problem-solving abilities.
  • Must be able to take after hour calls to meet business requirements as needed.

Job Requirements:

Education/Skills

  • Graduate of an accredited school of vocational nursing or equivalent required
  • Associate’s (ADN) or Bachelor’s (BSN) in Nursing preferred

Experience

  • 3 – 5 years of nursing experience preferred
  • Experience in Microsoft software (e.g., Outlook, Teams, Word, and Excel) required
  • General computer knowledge and capability to use computers required

Licenses, Registrations, or Certifications

  • LVN license in the state of employment or compact required
  • RN license in state of employment or compact preferred

 

Work Schedule:

5 Days - 8 Hours

Work Type:

Full Time

permanent
Product Review Engineer (Liaison Engineering) Consultant (Level 5)
🏢 Boeing
Salary not disclosed
AUBURN, WA 4 days ago

Job Description

At Boeing, we innovate and collaborate to make the world a better place. We’re committed to fostering an environment for every teammate that’s welcoming, respectful and inclusive, with great opportunity for professional growth. Find your future with us.


Job Description

The Boeing Commercial Airplanes Liaison Engineering Organization is seeking Consultant (Level 5) Liaison Engineers to support operations in Everett, Seattle, Auburn, and or Renton Washington. We are looking for a proactive individual who can make prompt engineering decisions and who want to go beyond their desk and into the factory for hands on engineering.

This position requires excellent communication and collaboration skills as the candidate will be partnering closely with production personnel.  The candidate will be the engineering representative on the factory floor transforming design into reality.

Position Responsibilities: 

  • Analyzes, conducts root cause analysis and develops dispositions for production non-conformances.
  • Applies knowledge of Boeing design principles to assess and resolve product/process issues through the product lifecycle.
  • Applies engineering principles to research technical, operational and quality issues in support of executing final engineering solutions.
  • Identifies documents, analyzes reported problems and communicates deviations that could impact design intent and safety; recommends and manages resolution.
  • Develops and implements product/process improvements.
  • Supports Integrated Product Teams (IPT) and participates in design reviews.
  • Represents the engineering community from initial build through the production and post-production environment.
  • Ensures supplier and build partner compliance with Boeing standards.
  • Develops customer correspondence for continued safe operation and maintenance of equipment.
  • Participates in on-site disabled product repair teams, accident investigation and support teams.
  • Analyzes damage repair or structural modification to determine appropriate jacking and shoring, prevent collateral damage and assure a safe work environment.
  • Designs interim structural repairs and conducts static strength analysis.
  • Develops non-destructive test procedures, tools and standards.

This position is fully onsite. The selected candidate will be required to work onsite at one of the listed locations. This position involves daily exposure to factory environment which includes stairs, trip hazards, high noise areas, chemical hazards (breathing and handling), and entering airplanes during their many stages of build.

This position participates in the approximately 9-month Boeing Company Training Rotation Program, which may involve assignments to the first, second, or third shift, as well as weekend or daily overtime. The specific requirements for shift assignments and overtime vary between sites and are typically covered on a rotation basis. Additionally, there may be travel involved between Boeing Puget Sound sites during the training rotation.

Basic Qualifications (Required Skills/Experience): 

  • Bachelor's or Masters of Science Degree from an ABET OR ABET equivalent accredited course of study in Engineering
  • 14+ years of experience in structures, systems, design, or production engineering

Preferred Qualifications (Desired Skills/Experience): 

  • Hands-on experience with materials and manufacturing processes.
  • Prior BCA Engineering Material Review Board (MRB) Certification

Conflict of Interest:

 Successful candidates for this job must satisfy the Company’s Conflict of Interest (COI) assessment 
process

Drug Free Workplace:

Boeing is a Drug Free Workplace where post offer applicants and employees are subject to testing for marijuana, cocaine, opioids, amphetamines, PCP, and alcohol when criteria is met as outlined in our policies.  

Shift:

This position is for multiple shifts and may require off shift, weekend, and travel assignments.

The candidate may periodically be assigned to first, second, or third shift as well as weekend or daily overtime. This requirement varies from site to site and is typically covered on a rotation basis.

Union:

This is a union represented position.

In locations where SPEEA representation applies, this job family will be covered by the terms of the collective bargaining agreement. Applicable and appropriate educational/certification credentials from an accredited institution and/or equivalent experience is required.
 

Pay and Benefits:

At Boeing, we strive to deliver a Total Rewards package that will attract, engage and retain the top talent.  Elements of the Total Rewards package include competitive base pay and variable compensation opportunities.  

The Boeing Company also provides eligible employees with an opportunity to enroll in a variety of benefit programs, generally including health insurance, flexible spending accounts, health savings accounts, retirement savings plans, life and disability insurance programs, and a number of programs that provide for both paid and unpaid time away from work.  

The specific programs and options available to any given employee may vary depending on eligibility factors such as geographic location, date of hire, and the applicability of collective bargaining agreements.

Pay is based upon candidate experience and qualifications, as well as market and business considerations.  

  • Summary pay range for Expert (level 5): $165,750 - $224,250

Applications for this position will be accepted until Mar. 20, 2026


Export Control Requirements:

This position must meet U.S. export control compliance requirements. To meet U.S. export control compliance requirements, a “U.S. Person” as defined by 22 C.F.R. §120.62 is required. “U.S. Person” includes U.S. Citizen, U.S. National, lawful permanent resident, refugee, or asylee.

Export Control Details:

US based job, US Person required

Relocation

This position offers relocation based on candidate eligibility.

Visa Sponsorship

Employer will not sponsor applicants for employment visa status.

Shift

This position is for 1st shift


Equal Opportunity Employer:

Boeing is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, national origin, gender, sexual orientation, gender identity, age, physical or mental disability, genetic factors, military/veteran status or other characteristics protected by law.

permanent
RN Clinical Review Nurse {167271}
Salary not disclosed
Alameda 6 days ago
Clinical Review Nurse Schedule for Clinical Review Nurse Monday – Friday | 8:00 AM – 5:00 PM Interview Process for Clinical Review Nurse One virtual interview Job Overview for Clinical Review Nurse We are seeking an experienced Clinical Review Nurse to support the investigation and resolution of complex member and provider grievances, appeals, and disputes .

This role is responsible for conducting detailed clinical reviews, evaluating medical necessity, and ensuring compliance with applicable regulatory requirements and organizational policies.

The Clinical Review Nurse will collaborate with internal teams and medical leadership to ensure timely and accurate resolution of cases while maintaining high standards of care and service.

Key Responsibilities for Clinical Review Nurse Conduct investigations and clinical reviews of member and provider grievances and appeals related to medical necessity .

Review prospective, inpatient, and retrospective medical records associated with denied services.

Summarize and present medical findings for Medical Directors, consultants, and external reviewers .

Apply clinical guidelines, policies, and benefit plan documentation when evaluating cases.

Prepare recommendations to uphold or overturn determinations and submit to the Medical Director for final approval.

Ensure appeals, grievances, and disputes are resolved within required regulatory timelines .

Evaluate requests for expedited review and determine urgency criteria.

Document case details and maintain accurate records within relevant tracking systems.

Draft written correspondence for members, providers, and regulatory entities .

Communicate with members, providers, and internal staff to support resolution of clinical concerns.

Identify potential quality-of-care concerns and escalate appropriately.

Serve as a clinical resource and subject matter expert to assist team members with appeals and grievance resolution.

Participate in additional projects and duties as assigned.

Essential Functions for Clinical Review Nurse Conduct thorough investigations of appeals, grievances, and provider disputes .

Evaluate the appropriateness of care within contractual, regulatory, and accreditation standards.

Identify system or process issues that may impact member care or service expectations and recommend improvements.

Perform documentation, reporting, and analytical tasks related to case reviews.

Maintain compliance with organizational policies, regulatory requirements, and professional standards .

Minimum Qualifications for Clinical Review Nurse Education / Licensing Active and unrestricted California Registered Nurse (RN) license Bachelor’s degree preferred Experience for Clinical Review Nurse Minimum 3 years of acute care clinical experience Minimum 2 years of appeals and grievances casework Preferred Experience for Clinical Review Nurse Utilization Management or Quality Management Experience applying standardized clinical guidelines Familiarity with Milliman Care Guidelines (MCG) , Managed Care, and NCQA standards Additional Details for Clinical Review Nurse No direct supervisory responsibilities Collaborative role working with clinical, operational, and leadership teams If you are an experienced nurse with strong clinical review and case evaluation skills and are looking to contribute to a team focused on quality care and regulatory excellence, we encourage you to apply.
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Not Specified
Registered Nurse Clinical Review-Hybrid-Los Angeles, California
Salary not disclosed
The Clinical Consultant – RN provides clinical leadership, consultation, and oversight across care management programs.

This role supports interdisciplinary care teams serving individuals with complex medical, behavioral health, and social needs, including people experiencing homelessness, serious mental illness, substance use disorders, chronic disease, and socioeconomic instability.

The Clinical Consultant – RN partners with Care Managers, Behavioral Health clinicians, Primary Care Providers, hospitals, Managed Care Plans, and community-based organizations to ensure high-quality, whole-person, and evidence-based care.

This position plays a critical role in care planning, clinical decision-making, transitions of care, medication management, quality improvement, and staff development while addressing social determinants of health and system barriers to care.

Essential Duties and Responsibilities Clinical Oversight & Consultation Provide clinical support and consultation to Care Managers, and interdisciplinary care teams across care management programs.

Serve as a clinical resource for chronic disease management, medication monitoring, and complex case review.

Guide staff in ensuring member safety and provide immediate consultation and escalation support for high-risk clinical situations.

Ensure clinical services align with evidence-based practices, regulatory standards, and program contracts, including requirements with Managed Care Plans (MCPs).

Care Planning & Coordination Provide clinical oversight and tracking of comprehensive intake assessments.

Participate in the development, review, and approval of patient-centered care plans, including initial plans and required updates.

Monitor progress toward care plan goals and recommend adjustments based on clinical findings and data.

Collaborate with Primary Care Providers, Behavioral Health clinicians, specialists, ACOs, MCOs, hospitals, and community partners to ensure services outlined in care plans are delivered.

Coordinate hospital admissions, discharges, and transitions of care to promote continuity, safety, and prevent avoidable readmissions.

Perform timely medication reconciliation following transitions of care and support medication adherence.

Data, Quality Improvement & Compliance Use data to evaluate outcomes of targeted interventions and assist in modifying care plans and care strategies accordingly.

Participate in quality improvement initiatives, audits, peer reviews, and program evaluations conducted by internal leadership, health plans, or external administrators.

Monitor continuous quality improvement measures through documentation review, clinical consultation, and chart audits.

Oversee charting and documentation standards to ensure compliance with contracts, program requirements, and organizational policies.

Documentation & Systems Complete and review care plans, assessments, and case notes using required systems (e.g., Salesforce, EHRs, or health plan platforms).

Maintain accurate, timely, and compliant documentation using SMART format where applicable.

Ensure confidentiality and compliance with HIPAA and all applicable federal and state regulations.

Staff Development & Team Collaboration Provide staff development training, coaching, and clinical guidance for care management staff.

Participate in weekly, bi-weekly, and monthly interdisciplinary care team meetings to review client progress, evaluate program effectiveness, and develop strategies to enhance care delivery.

Present cases and clinical insights during scheduled case conferences.

Attend required trainings, webinars, meetings, and conferences to maintain clinical excellence and program knowledge.

Support and expand programming that addresses social determinants of health and strengthens connections to community-based organizations.

Promote monthly health promotion topics and materials aligned with program priorities.

Expectations & Professional Standards Prioritize client health, safety, dignity, and self-determination.

Communicate with professionalism, tact, and cultural humility.

Demonstrate the ability to work under pressure and manage multiple complex priorities.

Maintain strict confidentiality and ethical standards.

Adapt effectively to change and support continuous improvement.

Model openness, honesty, accountability, and teamwork.

Demonstrate sensitivity to cultural, linguistic, and socioeconomic diversity.

Adhere to organizational safety policies, compliance standards, and guiding principles.

Required Qualifications Active and unrestricted Registered Nurse (RN) license in the State of California, in good standing.

Experience working with vulnerable populations, including individuals with histories of trauma, homelessness, substance use disorders, serious mental illness, or socioeconomic stress.

Strong clinical assessment, critical thinking, and problem-solving skills.

Comfort working autonomously in community-based and outreach settings.

Experience using data to track outcomes and measure performance.

Basic computer proficiency, including email, spreadsheets, and electronic documentation.

Valid California Driver’s License and proof of auto liability insurance meeting state of California minimum requirements.

Knowledge and applied practice of HIPAA compliance and healthcare regulations.

Preferred Qualifications Bilingual in English and Spanish.

Partners in Care Foundation is an equal opportunity employer.

We are committed to complying with all federal, state, and local laws providing equal employment opportunities, and all other employment laws and regulations.

It is our intent to maintain a work environment which is free of harassment, discrimination, or retaliation because of age, race (including hair texture and protective hairstyles, such as braids, locks, and twists), color, national origin, ancestry, religion, sex, sexual orientation, pregnancy (including childbirth, lactation/breastfeeding, and related medical conditions), physical or mental disability, genetic information (including testing and characteristics, as well as those of family members), veteran status, uniformed service member status, gender, gender identity, gender expression, transgender status, arrest or conviction record, domestic violence victim status, credit history, unemployment status, caregiver status, sexual and reproductive health decisions, salary history or any other status protected by federal, state, or local laws.

All qualified applicants will receive consideration for employment and reasonable accommodations may be made to enable qualified individuals to perform the essential functions of the position.
Remote working/work at home options are available for this role.
Not Specified
Clinical Data Review Pharmacist (onsite)
Salary not disclosed
West Jordan 3 days ago
A-Line Staffing is now hiring a Clinical Data Review Pharmacist in West Jordan, UT 84084.

The Clinical Data Review Pharmacist would be working for a Major Fortune 500 Company and has career growth potential.

Clinical Data Review Pharmacist Highlights: Schedule: ??? 6am to 2pm Monday to Friday ??? Sunday 3-11pm and Monday-Thursday 1-9pm OFF Friday/Saturday Pay Rate: $65/hr Clinical Data Review Pharmacist Responsibilities: Process prescription orders and perform clinical verification Consult with patients and providers as needed Support pharmacy programs that improve patient health outcomes, medication adherence, and prescription accuracy Clinical Data Review Pharmacist Qualifications: BS in Pharmacy or Doctor of Pharmacy (PharmD) Active Pharmacist License (RPh) Minimum 1 year of experience in a pharmacy environment If you are interested in this Clinical Data Review Pharmacist position, please apply to this posting with Luke H.

at A-Line!
Not Specified
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