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Job Description RN Care Coordinator at Zócalo Health Work From Home Compensation:$85,000 Work from Home (Must reside in California) Full-time #communityhealth #healthequity #latinohealth #healthcare About Us Zócalo Health is the first tech-driven provider built specifically for Latinos, by Latinos. We are developing a new approach to care that is designed around our very own shared and lived experiences and brings care to our gente. Founded in 2021 on the idea that our communities deserve more than just safety nets, we are backed by leading healthcare and social impact investors in the country to bring our vision to life. Our mission is to improve the lives of our communities—communities that have dealt with generations of poor experiences. These experiences include waiting hours in waiting rooms, spending mere minutes with doctors who don't speak their language, and depending on their youngest kids to help them navigate our complex healthcare system. At Zócalo Health, we meet our members where they are, bringing care into their homes and neighborhoods through our team of community-based care providers and virtual care offerings. We partner with community-based organizations, local healthcare providers, and health plans that recognize the value of culturally aligned care, which are not limited to brief interactions in an exam room. Together, we are building a new experience that revolves around the use of modern technology, culturally competent primary care, behavioral health, and social services to provide a radically better experience of care for every member, their family, and the communities we serve. We are committed to expanding our reach to serve more members and their communities. We are looking for passionate individuals who share our belief that healthcare should be accessible, personalized, and rooted in the community. Join us in our mission to ensure that no one has to navigate the complexities of the healthcare system alone and that everyone receives the local, culturally competent care they deserve. Role Description Zócalo Health is seeking a skilled and empathetic RN Care Coordinator to provide clinical care coordination for patients receiving services from our interdisciplinary team of board-certified physicians, nurse practitioners, and licensed behavioral health therapists. The RN Care Coordinator will play a critical role in supporting the implementation, monitoring, and continuous improvement of Zócalo Health's suite of clinical programs, including the Enhanced Care Management (ECM) program. This role will provide clinical oversight, ensure compliance with regulatory requirements, and help optimize care coordination and documentation processes. The RN Care Coordinator will work closely with the VP, Clinical Operations and serve as a clinical advisor and reviewer for the Community Health Worker (CHW) team. This role will initially report to the VP, Clinical Operations.. About the Role Clinical Oversight & Documentation • Review and provide clinical sign-off on ECM care plans developed by CHWs, ensuring alignment with clinical best practices, DHCS requirements, and plan-specific documentation standards., • Serve as the primary clinical point of contact for patients, ensuring seamless coordination of care across medical and behavioral health services, both internally with Zócalo Health providers and externally with specialists and other providers., • Facilitate timely referrals to specialty care, diagnostic tests, or community resources as needed., • Work collaboratively with Zócalo Health physicians and nurse practitioners to support implementation of care. Training & Collaboration • Collaborate with the Learning & Development and CHW leadership teams to support training related to clinical components of the ECM program and other care delivery models., • Stay current with relevant regulatory, Medi-Cal, and health plan-specific guidelines to ensure that documentation and clinical workflows remain compliant. Education: • Active, unrestricted RN license in the state of California., • Minimum 3 years of clinical experience in community-based care, case management, care coordination, or population health., • Familiarity with Medi-Cal, ECM, and population-based care models., • Familiarity with health plan portals, reporting systems, and EHRs (e.g., Athena)., • Ground floor opportunity; shape the direction of a fast-growing, high impact healthcare company, • Comprehensive benefits (medical/dental/vision), • Generous home office stipend, • Competitive compensation, • Generous PTO policy including 6 paid holidays. You must be authorized to work in the United States. We are open to remote work anywhere in the locations outlined in this job description. At Zócalo Health Inc., we see diversity and inclusion as a source of strength in transforming healthcare. We believe building trust and innovation are best achieved through diverse perspectives. To us, acceptance and respect are rooted in an understanding that people do not experience things in the same way, including our healthcare system. Individuals seeking employment at Zócalo Health are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. Those seeking employment at Zócalo Health are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.

Job Description About Us: VOALA Helping Our Most Vulnerable Change Their Life Stories Volunteers of America is a non-profit human services organization committed to serving people in need, strengthening families, and building communities. VOALA provides a variety of social services to Los Angeles area communities such as Head Start programs, Upward Bound college prep programs, veterans’ services, homeless shelters, low-income housing program as well as drug and alcohol rehabilitation. Learn more at . PAY RATE: $29.18 - $30.72 Per Hour BENEFITS: VOALA offers competitive medical, dental, vision and retirement benefits. JOB SUMMARY AND PURPOSE Under the direction of a Quality Assurance Coordinator, the Quality Assurance Reviewer II performs Quality Assurance review and audit of VOALA Program documentation and database practices related to grant, contract and legal requirements as well as organization policies and initiatives for assigned human services programs. The QA Department provides dedicated QA teams (Quality Assurance Reviewers and Quality Assurance Coordinators) to support VOALA Programs’ ability to be “audit ready.” DUTIES AND RESPONSIBILITIES • Conduct Quality Assurance procedures with their assigned VOALA Programs:, • Execute QA procedures to ensure that VOALA Program files are accurate and meet funder requirements (both hard copy and electronic databases), • Performs QA audit for every assigned VOALA program each fiscal year, • Strives to have all assigned VOALA programs “audit ready” for external audits, • Acquire broad knowledge of assigned program contracts and grants and their requirements through research and continuous engagement with programs, • Perform special audits of programs with corrective action plans or as otherwise identified by Director of Evaluation and Monitoring. Provide additional support to programs to ensure corrections are made. Provide related training where needed., • Handles more complex programs as assigned by Quality Assurance Coordinator, • Provides assistance to peers and HMIS specialists as needed, • Support programs prior to funder audits and ensure all requirements are in place. Review audit results from funders’ audits. Participate in after audit review of audits., • Perform Quality Assurance (QA) in support of VOALA programs, ensure Program records and procedures meet funder requirements and are ready to pass funder audits., • Stay current with assigned VOALA Program grants/contracts,, • Conduct special audits of Programs, as directed by Director of Evaluation and Monitoring; identify corrective action needed, • Support Programs prior to, during, and subsequent to funder audits; Participate in after audit reviews of all external audits. REQUIREMENTS: • 3 years of experience in quality assurance or data driven environment Experience in data entry and database operations; familiarity with HMIS and/or Service Point * Working knowledge of Medi-Cal regulations, especially relating to provision of substance abuse treatment Volunteers of America is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law. This employer participates in E-Verify as required by the federal government and will provide the federal government with your Form 1-9 information to confirm that you are authorized to work in the U.S. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (OHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment.

Job Description About Us: VOALA Helping Our Most Vulnerable Change Their Life Stories Volunteers of America is a non-profit human services organization committed to serving people in need, strengthening families, and building communities. VOALA provides a variety of social services to Los Angeles area communities such as Head Start programs, Upward Bound college prep programs, veterans’ services, homeless shelters, low-income housing program as well as drug and alcohol rehabilitation. Learn more at . PAY RATE: $24.84 - $26.15 Per Hour BENEFITS: VOALA offers competitive medical, dental, vision and retirement benefits. JOB SUMMARY AND PURPOSE Under the direction of a Quality Assurance Coordinator, the Quality Assurance Reviewer I performs Quality Assurance review and audit of VOALA Program documentation and database practices related to grant, contract and legal requirements as well as organization policies and initiatives for assigned human services programs. The QA Department provides dedicated QA teams (Quality Assurance Reviewers and Quality Assurance Coordinators) to support VOALA Programs’ ability to be “audit ready.” DUTIES AND RESPONSIBILITIES • Conduct Quality Assurance procedures with their assigned VOALA Programs:, • Execute QA procedures to ensure that VOALA Program files are accurate and meet funder requirements (both hard copy and electronic databases), • Performs QA audit for every assigned VOALA program each fiscal year, • Strives to have all assigned VOALA programs “audit ready” for external audits, • Acquire broad knowledge of assigned program contracts and grants and their requirements through research and continuous engagement with programs, • Perform special audits of programs with corrective action plans or as otherwise identified by Director of Evaluation and Monitoring. Provide additional support to programs to ensure corrections are made. Provide related training where needed., • Support programs prior to funder audits and ensure all requirements are in place. Review audit results from funders’ audits. Participate in after audit review of audits., • Perform Quality Assurance (QA) in support of VOALA programs, ensure Program records and procedures meet funder requirements and are ready to pass funder audits., • Stay current with assigned VOALA Program grants/contracts,, • Conduct special audits of Programs, as directed by Director of Evaluation and Monitoring; identify corrective action needed, • Support Programs prior to, during, and subsequent to funder audits; Participate in after audit reviews of all external audits. REQUIREMENTS: • 1 year of experience in quality assurance or data driven environment, • Experience in data entry and database operations; familiarity with HMIS and/or Service Point This employer participates in E-Verify as required by the federal government and will provide the federal government with your Form 1-9 information to confirm that you are authorized to work in the U.S. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (OHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment.

Immediate need for a talented Authorization Specialist. This is a 06+months contract opportunity with long-term potential and is located in CA(Remote). Please review the job description below and contact me ASAP if you are interested. Job ID: 25-83330 Pay Range: $20 - $21/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location). Key Responsibilities: • Shift Schedule: 8 AM - 5 PM PST Mon To Fri, • Training Schedule: 4 weeks; 8 AM - 5 PM PST Mon To Fri, • Support authorization requests for services in accordance with the insurance prior authorization list, • Support and perform data entry to maintain and update authorization requests into utilization management system, • Assist utilization management team with ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines, • Contribute to the authorization review process by documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination, • Remain up to date on healthcare, authorization processes, policies, and procedures, • Perform other duties as assigned, • Comply with all policies and standards Key Requirements and Technology Experience: • Key Skills; Understanding of medical terminology and insurance preferred, • Medical background and authorization experience, • Medicaid experience, excel background, • Microsoft Suite, • Understanding of medical terminology and insurance preferred, • Medical background and authorization experience, • Medicaid experience, excel background, • Microsoft Suite, • High school diploma Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration. Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.

Job Description Utilization Management Nurse Reviewer About the Position HealthSmart Management Services Organization, Inc. is looking for a full-time qualified UM Nurse Reviewer who will be responsible for reviewing and processing Authorization requests of medical services from health professions, clinical facilities and ancillary providers. Qualified candidate will coordinate with Providers and their office designees as a resource for their various inquiries and needs. Experience & Education Requirements: • High School Graduate or equivalent required., • Current unrestricted RN or LVN License to practice in the State of California., • Minimum of three (3) years current clinical experience preferred., • IPA and Managed care experience preferred., • Knowledge of medical criteria for Apollo, MCG and Medicare/Medi-Cal guidelines., • Excellent telephone skills required., • Computer experience desirable., • Excellent interpersonal skills., • ICD 10- CM and CPT/ HCPCS Medical Coding, • Accurate processing of referrals for assigned medical group(s), which includes:, • Eligibility verification, • Receives reviews, verifies and processes requests for referrals, diagnostic testing, inpatient admissions, outpatient procedures/testing, emergency room notification, home health care services, and durable medical equipment and supplies via telephone, fax or on-line portal., • Reviewing all adverse decisions for accuracy of member-specific information and appropriateness of lay language regarding the Physician Reviewer’s decision. Works closely with Denial Coordinator, Physician Reviewer, and Director of Utilization Management for use of criteria/guidelines, • Utilization of mandatory UM Nurse documentation to include Hierarchy of criteria used to either make decision (based on IPA Matrix) or to assist Physician Reviewers in criteria review., • Reviews for potential CCS eligible conditions and notify appropriate CCS designated staff for processing., • Review of prior activity, • Ensure coordination of services, where necessary, • Ensure timeliness of notification to providers (and members, when indicated), • Timely processing of referrals for assigned medical group(s) according to timeliness chart., • Maintain coordination of services between health plans, CCS, Case Management, Linked services, etc., • Maintain professional interaction with Medical Directors, Physician Reviewers, IPA Physicians and staff, Nurse/Case Managers for Outpatient coordination of Case Management cases, Fellow coworkers, etc., • Maintain compliance with UM Plan and Policy and Procedures as related to your role as a Nurse Reviewer, • Maintain compliance with HIPAA rules and regulations. · Typical office environment with no unusual hazards. · Repetitive movements with use of keyboard, mouse, and phone. · Constant sitting while using the computer terminal. · Constant use of sight abilities while reviewing documents. · Regularly speak and listen in person, telephone, and remote meetings · Constant mental alertness must possess planning/organizing skills and must be able to work under deadlines. · Occasionally required to stand, walk, stoop, kneel, bend, crouch and lift up to but not more than 10 pounds. HealthSmart Management Service Organization, Inc provides a full suite of benefits: · Generous contribution toward individual and dependent Medical and Dental Insurance. · Vision Insurance. · Supplemental Short Term and Long-Term Disability Insurance. · Voluntary Life Insurance for subscriber and dependents. · Flexible Spending Account. · Generous Paid Time Off plan. · Paid Holidays. · Flexible Spending Accounts. · Discretionary Bonuses. Company DescriptionHealthSmart MSO, Inc. (HSMSO) is a management service organization serving the needs of providers in a managed care setting. Our Vision is to motivate, facilitate, and create opportunities for our client’s and team. HealthSmart MSO’s goal is to ensure its Managed IPA’s, Medical Groups, Hospitals and Physician Practices have a coordinated cost effective delivery system where quality services to members and physicians are achieved. Together, members and providers work toward a common goal of wellness and preventive medicine. As needs arise, physicians and their members feel comfortable knowing that they will receive care from the most dedicated and friendly managed care team.HealthSmart MSO, Inc. (HSMSO) is a management service organization serving the needs of providers in a managed care setting. Our Vision is to motivate, facilitate, and create opportunities for our client’s and team. HealthSmart MSO’s goal is to ensure its Managed IPA’s, Medical Groups, Hospitals and Physician Practices have a coordinated cost effective delivery system where quality services to members and physicians are achieved. Together, members and providers work toward a common goal of wellness and preventive medicine. As needs arise, physicians and their members feel comfortable knowing that they will receive care from the most dedicated and friendly managed care team.

Job Description Dane Street is expanding our physician panel! This is a telework opportunity for supplemental income for physicians providing a caseload customized to your schedule. Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case basis. The ideal candidates will hold a CA license and be Board Certified in Internal Medicine, with experience in completing FMLA and disability Independent Medical Exams. Independent Medical Exam must be completed within 50 miles of City of Industry, CA. Requirements As Physician Reviewer/Advisor, you will utilize clinical expertise and reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will provide an interpretation of the medical necessity of services provided by other healthcare professionals in compliance with client specific policies, nationally recognized evidence-based guidelines, and standards of care. MAJOR DUTIES AND RESPONSIBILITIES: • Reviews all medical records and addresses each question posed by the client utilizing client specific criteria or other nationally recognized evidence-based criteria, • Ensures that the rationale for the determination is clear, concise, and contains adequate supporting documentation to substantiate the decision, • Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature that support sound and objective decision-making and rationales in reviews; refrains from using case studies, cohorts, and the like to make decisions due to their limited sample sizes, • Provides copies of any criteria utilized in a review with the report in a timely manner, • Returns cases on or before the due date and time, • Makes telephone calls as mandated by the state and/or client specifics, • Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job, • Attends all required orientation and training, • Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits, • Board certification required, active practice required PLEASE BE AWARE: In the interest of the security of all parties, Dane Street will never conduct interviews via text or request checks from candidates for any reason including the purchase of equipment. Benefits Robust opportunity for supplemental income • Schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct exams and reviews based on your schedule availability, • No doctor/patient relationship is established and no treatment is provided. These are advisory-only opinions., • Enhanced industry expertise strengthening your medical practice with medical necessity and utilization review/management expertise, • Expanded credentials as an expert in Independent Medical Exams and physician advisor services, • Fully prepped cases, streamlined case flow, transcription services at no cost, and user-friendly work portal Dane Street supports all referral processes, scheduling, preps cases extensively, prepares all medical records, provides transcription services as applicable, facilitates all client communications, and ensures the quality and timeliness of all reports and report delivery. Apply for this job