Student Veterans of America Jobs

Welcome to SVA’s jobs portal, your one-stop shop for finding the most up to date source of employment opportunities. We have partnered with the National Labor Exchange to provide you this information. You may be looking for part-time employment to supplement your income while you are in school. You might be looking for an internship to add experience to your resume. And you may be completing your training ready to start a new career. This site has all of those types of jobs.

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Job Information

Amergis Insurance RN/$112k/Leadership in Fresno, California

At Amergis Healthcare Staffing we are passionate about connecting people to work that matters while filling critical staffing needs so patients never go without care.

This great opportunity is ideal for a detailed oriented RN with a background on insurance policy. Our client is looking for someone with auditing experience, leadership qualities, and has a strong focus on quality assurance.

Continue reading the rest of this post and if it's a position that you'd be interested in exploring more, send us your resume and we'll reach out to schedule a phone conversation.

POSITION SUMMARY:

You would be responsible for oversight and management of health policies for a large insurance provider. You'll also be running quality improvement programs and initiatives to ensure compliance with state and federal requirements.

Under the direction of the Director of Medical Management and the Chief Medical Officer, the Medical Management Manager will work closely with their Team and its contracted Plan Administrator to monitor and report on clinical, service, and quality related data and issues. You will also be responsible with writing and improving policies and processes within the department.

ESSENTIAL DUTIES & RESPONSIBILITIES:

  • Manage and oversee the review and revision of Medical Management policies and procedures to ensure they address current and new applicable statutes and/or regulations.

  • Manage directly reporting Medical Management staff and oversee department activities.

  • Manage the review, preparation, and submission of documents and policies for the DHCS/DMHC Medical Audits.

  • Lead the delegation audit process, develop reports regarding audits, and analyze, track and trend audit findings.

  • Coordinate preparation for the Appeals and Grievances Work Group including draft agenda & minutes, report gathering and follow up.

  • Prepare and review required reports, program documents and workplans as requested.

  • Support and participate in Quality Improvement projects and teams including meeting agendas, tracking logs and regulatory submissions.

  • Attend Quality Improvement/Utilization Management Committee, QI Work Group, Monthly Case Management, Utilization Management.

  • Interact with HNCS staff as necessary in fulfilling duties of this job description.

  • Function as back up for the Appeal & Grievance file transfer process including auditing the cases to ensure files are complete and ready for regulatory audits.

  • Other duties as assigned by the Director.

MINIMUM QUALIFICATIONS/EDUCATION:

  • Registered Nurse required.

  • Healthcare related bachelor’s degree.

  • Master’s degree –MPH or MPA-- is highly desirable.

  • Certification in Healthcare Quality (CPHQ) desirable.

EXPERIENCE:

  • Five years progressive experience in Healthcare Quality Improvement and/or Project Management.

  • Previous managerial experience preferred.

  • Minimum of two years’ experience in healthcare service environment.

KNOWLEDGE, SKILLS & ABILITIES:

  • Strong knowledge of healthcare federal, state and NCQA standards and regulations.

  • Knowledge of Managed Care Operations.

  • Ability to effectively develop, analyze, interpret, and communicate healthcare data reports and processes.

  • Effective verbal and written communication skills.

  • Strong organizational, analytical and problem-solving skills.

  • Must be proficient in Microsoft Office: Word, Excel, PowerPoint, Access and Outlook.

  • Possess the ability to effectively organize and prioritize projects and multi-task.

  • Ability to take initiative and work independently.

  • Team player who can establish and maintain effective working relationships at all organization levels.

  • Exercise a high degree of maturity, integrity, loyalty, initiative, creativity and sound judgment.

OTHER DETAILS

  • Location - Fresno, CA

  • Schedule: Mon-Fri, 8am-5pm. In office only. Not remote.

  • Position Type: Direct Hire

  • Salary: $85k-$112k

If you're interested in learning more about this position, submit your resume and we will reach out to schedule a phone interview.

Benefits

At Amergis, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits:

  • Competitive pay & weekly paychecks

  • Health, dental, vision, and life insurance

  • 401(k) savings plan

  • Awards and recognition programs

    *Benefit eligibility is dependent on employment status.

    About Amergis

Amergis, formerly known as Maxim Healthcare Staffing, has served our clients and communities by connecting people to the work that matters since 1988. We provide meaningful opportunities to our extensive network of healthcare and school-based professionals, ready to work in any hospital, government facility, or school. Through partnership and innovation, Amergis creates unmatched staffing experiences to deliver the best workforce solutions.

Amergis is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.

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