- Elevance Health (Costa Mesa, CA)
- **Diagnosis Related Group Clinical Validation Auditor -RN** **Virtual:** This role enables associates to work virtually full-time, with the exception of required ... onboarding and skill development. The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records to ensure… more
- Sharp HealthCare (San Diego, CA)
- …National Association for Healthcare Quality; HPCC Certified Hospice and Palliative Nurse (CHPN) - Hospice and Palliative Credentialing Center; HPCC Certified Hospice ... Administrator (CHPCA) - Hospice and Palliative Credentialing Center; California Registered Nurse (RN) - CA Board of Registered Nursing; Bachelor's Degree **Hours**… more
- The Cigna Group (Sacramento, CA)
- …**Job Description Summary** Provides advanced professional input to complex Nurse Case Management assignments/projects. Plans, implements, and evaluates appropriate ... to develop models and procedures, and monitor trends, within Nurse Case Management. RN and current unrestricted nursing license...+ May be required to participate in customer and auditor visits. + Participates in special projects as deemed… more
- Highmark Health (Sacramento, CA)
- …(any of the following) + Certified Public Accountant (CPA) + Certified Information Systems Auditor (CISA) + Juris Doctor (JD) + PharmD + Registered Nurse (RN) ... **SKILLS** + Demonstrate knowledge of business and technology processes, risk and control frameworks, and assessment methodologies, particularly as applied to healthcare (payer and provider) business processes + Knowledge of relevant regulatory guidelines,… more