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LEAD QUALITY RISK MANAGEMENT (LVN - Grievance/Appeals)- Full Time

Job Description

Responsibilities

Come and join the RMC Family! 

We have been in the community since 1935.  Our mission is to provide comprehensive multi-specialty medical services in the greater Riverside region.  Your passion, inspiration, and talents are invaluable to us and our mission to serve others.  Our facility can provide a place for you to thrive and continue your professional development.  Quality Healthcare is our passion, improving lives is our reward.  We are working to change lives and transform the delivery of healthcare. Riverside Medical Clinic is the best place to work, practice medicine, and receive care.

 

SUMMARY: Prepare Health Plan required reports, Action plans from audits (CAPs), medical record audits, coordinate annual HEDIS Data Collection, conduct relevant QI studies, and coordinate CPPI. Review/respond to grievances and appeals, monthly medication inventory audit, and monitor any other quality indicators.

 

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

HOURS: Monday - Friday, 830a - 530p


Qualifications

EDUCATION and/or EXPERIENCE: Associates degree from an accredited college or University. Two (2) to Three (3) years of experience. 

 

CERTIFICATION, LICENSES, AND REGISTRATIONS: Current California LVN License required and CPHQ is a plus.

 

*Benefit Highlights:

  • Challenging and rewarding work environment.
  • Competitive compensation and paid time off.
  • Excellent Medical, Dental, Vision and Life Insurance Plans.
  • 401(K) with company match and discounted stock plan. 

*Full time employees. Part time employees could be eligible 

 

EEO Statement:

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

 

Notice:

At UHS and all subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates with matching skillset and experience with the best possible career at UHS and our subsidiaries.  We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail etc. If you feel suspicious of a job posting or job-related email, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.

 

Pay Transparency:

To encourage pay transparency, promote pay equity, and proactively address regulations, UHS and all our subsidiaries will comply with all applicable state or local laws or regulations which require employers to provide wage or salary range information to job applicants and employees. Salary offers may be based on key factors such as education and related experience.

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