clinical quality coordinator, entry

clinical success director - nursing Jobs in California

clinical success director - nursing

online | customer care coordinator | entry level Jobs in California

clinical quality coordinator entry

Blue Shield of California

<div>
 
 Job Description
 
 
 
 
 Your Role
 
 
 
 The Clinical Quality team oversees and is responsible of HEDIS medical record review, pursuit, and overall HEDIS submission. The Clinical Quality Coordinator, Entry will report to the Supervisor of the HEDIS Outreach Team. In this role you will be responsible for conducting provider outreach during the HEDIS season for medical record pursuit and retrieval. Also, participation in Quality initiatives involving member outreach for care gap closure. Responsible for maintaining high productivity and standard work.
 
 
 Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow &ndash; personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
 
 
 
 Responsibilities
 
 
 
 
 Your Work
 
 
 
 
 In this role, you will:
 
 
 
 <ul>
 <li>
 Initiate outbound calls to members and providers to collect information and provide care coordination assistance in obtaining services (schedule appointments, provider appointment reminders, coordinate transportation, etc.)
 </li>
 <li>
 Educate members on missing care gaps and provide encouragement to obtain missing service.
 </li>
 <li>
 Request medical records from PCP/Specialists by fax, remote EMR access or scheduled site visits as needed
 </li>
 <li>
 Manage and maintain HEDIS files and medical records
 </li>
 <li>
 Provide administrative support, including generating correspondence, organize mass mailings, coordinator schedules and training
 </li>
 <li>
 Continued development of understanding of HEDIS hybrid measures and medical record requirements for HEDIS compliance
 </li>
 <li>
 Research member claims and encounters to identify accurate pursuit information for medical record retrieval
 </li>
 <li>
 Review medical records and identify elements for compliance
 </li>
 <li>
 Create and maintain detailed logs of member and provider interactions
 </li>
 <li>
 Ability to de-escalate situations
 </li>
 <li>
 Assist in onboarding contingent workforce for HEDIS and outreach projects
 </li>
 <li>
 EMR and vendor portal medical record retrieval
 </li>
 <li>
 Developing understanding of HEDIS pursuit processes relative to pursuit systems and tracking processes
 </li>
 <li>
 Developing understanding of outreach and pursuit project intake procedures, schedules, and reporting requirements
 </li>
 <li>
 Ability to work independently in a fast-paced environment with minimal errors
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 
 Your Knowledge and Experience
 
 
 
 <ul>
 <li>
 Requires a high school diploma or equivalent
 </li>
 <li>
 Requires limited knowledge of systems and procedures
 </li>
 <li>
 Typically, has limited or no prior experience
 </li>
 <li>
 Communication and interpersonal skills
 </li>
 <li>
 Must be organized with the ability to keep accurate notes and records
 </li>
 <li>
 Customer service experience is preferred
 </li>
 <li>
 HEDIS knowledge strongly preferred
 </li>
 <li>
 Critical thinking skills
 </li>
 <li>
 Knowledge of computer applications including Microsoft Word, PowerPoint and Excel. Internet knowledge with the ability to complete searches
 
 
 </li>
 </ul>
 
 Hybrid Virtual Work
 
 
 
 This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.
 
 
 
 About The Team
 
 
 
 
 About Blue Shield of California
 
 
 
 As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
 
 
 At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
 
 
 To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
 
 
 Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities &ndash; join us!
 
 
 
 Our Values:
 
 
 
 <ul>
 <li>
 Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
 </li>
 <li>
 Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
 </li>
 <li>
 Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
 
 
 </li>
 </ul>
 
 Our Workplace Model
 
 
 
 We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
 
 
 <ul>
 <li>
 For most teams, this means coming into the office two days per week.
 </li>
 <li>
 Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
 </li>
 <li>
 For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
 
 
 </li>
 </ul>
 The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
 
 
 
 Physical Requirements:
 
 
 
 Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
 
 
 Please click here for further physical requirement detail.
 
 
 
 Equal Employment Opportunity:
 
 
 
 External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
</div>

Clinical Quality Coordinator, Entry

Monogram Health

<div>
 
 Position:
 
 
 
 Concurrent Review Ops Assistant
 
 
 
 
 The
 
 Concurrent Review Ops Assistant
 
 is a key member of the Clinical Review Specialist Team that is responsible for critical administrative day-to-day tasks associated with operations to deliver transformative kidney care.
 
 
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Assist in processing Health Plan(s) and Contracted Provider(s) daily files and uploads for all acute and post-acute admissions
 </li>
 <li>
 Assist with inpatient and concurrent calls to verify and confirm admission and obtain member information
 </li>
 <li>
 Assist with monitoring skilled nursing facility discharges
 </li>
 <li>
 Create Care Events as needed for new admissions to be followed by the Clinical Review Team
 </li>
 <li>
 Request clinical as needed; retrieve and document clinical from our EMR system(s).
 </li>
 <li>
 Communicate with the care team and other internal and external stakeholders
 </li>
 <li>
 Analyze data and develop reports/presentations
 </li>
 <li>
 Ability to multitask and prioritize in a busy work environment
 </li>
 <li>
 Maintain safe, secure, and healthy work environment by establishing and following standards and procedures and complying with legal regulations
 
 
 </li>
 </ul>
 
 Position Requirements
 
 
 
 <ul>
 <li>
 High school diploma or GED required
 </li>
 <li>
 Minimum of two (2) years of experience analyzing and solving customer problems
 </li>
 <li>
 Proven experience working in the health care industry and working with medical terminology
 </li>
 <li>
 Firm grasp on administrative processes and organizational policies
 </li>
 <li>
 Understanding and appreciation of patient privacy laws, regulations, policies, and procedures.
 </li>
 <li>
 Demonstrated customer service and professional communication skills, both written and verbal. Organizational and time management skills, with ability to multitask and maintain attention to detail.
 </li>
 <li>
 Timely, reliable, and supportive of team goals and outcomes by completing daily tasks.
 </li>
 <li>
 Technically savvy when handling video and audio meetings.
 </li>
 <li>
 Proficient in Microsoft Office ? predominately Excel
 
 
 </li>
 </ul>
 
 Benefits
 
 
 
 <ul>
 <li>
 Comprehensive Benefits - Medical, dental, and vision insurance, employee assistance program, employer-paid and voluntary life insurance, disability insurance, plus health and flexible spending accounts
 </li>
 <li>
 Financial &amp; Retirement Support ? Competitive compensation, 401k with employer match, and financial wellness resources
 </li>
 <li>
 Time Off &amp; Leave ? Paid holidays, flexible vacation time/PSSL, and paid parental leave
 </li>
 <li>
 Wellness &amp; Growth ? Work life assistance resources, physical wellness perks, mental health support, employee referral program, and BenefitHub for employee discounts
 
 
 </li>
 </ul>
 
 About Monogram Health
 
 
 
 Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person?s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders.
 
 
 Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient?s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home.
 
 
 Monogram Health?s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum.
</div>

Concurrent Review Operations Assistant

DataAnnotation

<div>
 We are looking for a Respiratory Therapist to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of each model.
 
 
 
 Physicians &amp; Advanced Practice Clinicians
 
 
 
 In this role you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include:
 
 
 Physicians of all specialties (e.g., Internists, Cardiologists, Oncologists), Physician Assistants, Nurse Practitioners, Certified Nurse-Midwives, Certified Registered Nurse Anesthetists, Clinical Nurse Specialists, Registered Nurses.
 
 
 
 Therapists
 
 
 
 Physical Therapists, Occupational Therapists, Speech-Language Pathologists, Respiratory Therapists, Athletic Trainers, Massage/Recreational Therapists.
 
 
 
 Diagnostic &amp; Laboratory Professionals
 
 
 
 Radiologic Technologists, Sonographers, MRI &amp; Nuclear Medicine Technologists, Medical Laboratory Scientists, Phlebotomists, Histology &amp; Genetics Technicians.
 
 
 
 Public Health &amp; Specialized Roles
 
 
 
 Dietitians/Nutritionists, Genetic Counselors, Epidemiologists, Public Health Nurses.
 
 
 
 Benefits
 
 
 
 <ul>
 <li>
 This is a full-time or part-time REMOTE position
 </li>
 <li>
 You&rsquo;ll be able to choose which projects you want to work on
 </li>
 <li>
 You can work on your own schedule
 </li>
 <li>
 Projects are paid hourly starting at $50-$60 USD per hour, with bonuses on high-quality and high-volume work
 
 
 </li>
 </ul>
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Give AI chatbots diverse and complex healthcare related problems and evaluate their outputs
 </li>
 <li>
 Evaluate the quality produced by AI models for correctness and performance
 </li>
 <li>
 Ensure the medical accuracy of model performance
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Fluency in English (native or bilingual level)
 </li>
 <li>
 A current or in progress medical degree
 
 
 </li>
 </ul>
 Notes: Payment is made via PayPal. We will never ask for any money from you. PayPal will handle any currency conversions from USD. Only applicants in the United States will be considered for this role. This is an independent contract position.
 
 
 #medicine
</div>

Respiratory Therapist

<div>
 We are looking for medical experts to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of each model.
 
 
 
 Role
 
 
 
 In this role you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include:
 
 
 Physicians &amp; Advanced Practice Clinicians: Physicians of all specialties (e.g., Internists, Cardiologists, Oncologists), Physician Assistants, Nurse Practitioners, Certified Nurse-Midwives, Certified Registered Nurse Anesthetists, Clinical Nurse Specialists, Registered Nurses.
 
 
 Therapists: Physical Therapists, Occupational Therapists, Speech-Language Pathologists, Respiratory Therapists, Athletic Trainers, Massage/Recreational Therapists.
 
 
 Diagnostic &amp; Laboratory Professionals: Radiologic Technologists, Sonographers, MRI &amp; Nuclear Medicine Technologists, Medical Laboratory Scientists, Phlebotomists, Histology &amp; Genetics Technicians.
 
 
 Public Health &amp; Specialized Roles: Dietitians/Nutritionists, Genetic Counselors, Epidemiologists, Public Health Nurses.
 
 
 
 Benefits
 
 
 
 This is a full-time or part-time REMOTE position
 
 
 You&rsquo;ll be able to choose which projects you want to work on
 
 
 You can work on your own schedule
 
 
 Projects are paid hourly starting at $40+ per hour, with bonuses on high-quality and high-volume work
 
 
 
 Responsibilities
 
 
 
 Give AI chatbots diverse and complex healthcare related problems and evaluate their outputs
 
 
 Evaluate the quality produced by AI models for correctness and performance
 
 
 Ensure the medical accuracy of model performance
 
 
 
 Qualifications
 
 
 
 Fluency in English (native or bilingual level)
 
 
 A current or in progress medical degree
 
 
 
 Notes
 
 
 
 Payment is made via PayPal
 
 
 We will never ask for any money from you
 
 
 PayPal will handle any currency conversions from USD
 
 
 Only applicants in the United States will be considered for this role
 
 
 This is an independent contract position.
 
 
 #MEDICINE
</div>

Clinical Nurse

<div>
 We are looking for a Nurse to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of each model.
 
 
 
 Physicians &amp; Advanced Practice Clinicians
 
 
 
 In this role you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include:
 
 
 Physicians of all specialties (e.g., Internists, Cardiologists, Oncologists), Physician Assistants, Nurse Practitioners, Certified Nurse-Midwives, Certified Registered Nurse Anesthetists, Clinical Nurse Specialists, Registered Nurses.
 
 
 
 Therapists
 
 
 
 Physical Therapists, Occupational Therapists, Speech-Language Pathologists, Respiratory Therapists, Athletic Trainers, Massage/Recreational Therapists.
 
 
 
 Diagnostic &amp; Laboratory Professionals
 
 
 
 Radiologic Technologists, Sonographers, MRI &amp; Nuclear Medicine Technologists, Medical Laboratory Scientists, Phlebotomists, Histology &amp; Genetics Technicians.
 
 
 
 Public Health &amp; Specialized Roles
 
 
 
 Dietitians/Nutritionists, Genetic Counselors, Epidemiologists, Public Health Nurses.
 
 
 
 Benefits
 
 
 
 <ul>
 <li>
 This is a full-time or part-time REMOTE position
 </li>
 <li>
 You&rsquo;ll be able to choose which projects you want to work on
 </li>
 <li>
 You can work on your own schedule
 </li>
 <li>
 Projects are paid hourly starting at $50-$60 USD per hour, with bonuses on high-quality and high-volume work
 
 
 </li>
 </ul>
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Give AI chatbots diverse and complex healthcare related problems and evaluate their outputs
 </li>
 <li>
 Evaluate the quality produced by AI models for correctness and performance
 </li>
 <li>
 Ensure the medical accuracy of model performance
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Fluency in English (native or bilingual level)
 </li>
 <li>
 A current or in progress medical degree
 
 
 </li>
 </ul>
 Notes: Payment is made via PayPal. We will never ask for any money from you. PayPal will handle any currency conversions from USD. Only applicants in the United States will be considered for this role. This is an independent contract position.
 
 
 #medicine
</div>

Nurse

Aisles & Abroad Careers

<div>
 
 Position Overview
 
 
 We are seeking a reliable and service-focused
 
 Customer Care Coordinator
 
 to support client communications and assist with coordination tasks. This role centers on providing timely support, managing inquiries, and ensuring a smooth and positive experience for clients throughout the process.
 
 
 This is a fully remote position ideal for individuals who are responsive, organized, and enjoy working in a customer-focused environment.
 
 
 
 Key Responsibilities
 
 
 
 <ul>
 <li>
 Serve as a point of contact for client inquiries and support requests
 </li>
 <li>
 Assist with coordinating services, scheduling, and follow-ups
 </li>
 <li>
 Provide clear and professional communication regarding updates and next steps
 </li>
 <li>
 Maintain accurate records of client interactions and requests
 </li>
 <li>
 Monitor tasks and ensure timely responses and resolutions
 </li>
 <li>
 Support a positive and consistent client experience
 
 
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Strong communication and interpersonal skills
 </li>
 <li>
 Excellent organizational and time management abilities
 </li>
 <li>
 Ability to work independently in a remote setting
 </li>
 <li>
 Detail-oriented with the ability to manage multiple tasks
 </li>
 <li>
 Comfortable using email, messaging platforms, and online systems
 
 
 
 
 </li>
 </ul>
 
 Preferred (Not Required)
 
 
 
 <ul>
 <li>
 Experience in customer service, support, or coordination roles
 </li>
 <li>
 Interest in travel, hospitality, or event-related services
 
 
 
 
 </li>
 </ul>
 
 What We Offer
 
 
 
 <ul>
 <li>
 Flexible remote work environment
 </li>
 <li>
 Structured onboarding and ongoing support
 </li>
 <li>
 Opportunities for growth and advancement based on performance
 </li>
 <li>
 Supportive and collaborative team environment
 
 
 
 
 </li>
 </ul>
 
 Work Environment
 
 
 This is a remote role requiring a reliable internet connection and the ability to stay organized and responsive in a virtual workspace.
 
 
 
 Apply Today
 
 
 If you enjoy helping others, managing communication, and providing a high level of service in a remote environment, we encourage you to apply.
 
 
 We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
</div>

Online | Customer Care Coordinator | Entry Level

NPHire

<div>
 
 A world-renowned academic hematology/oncology program in Los Angeles, California is seeking an
 
 Acute Care Nurse Practitioner (AGACNP)
 
 for a full-time inpatient role managing some of the most complex hematologic malignancy cases in the country &mdash; leukemia, lymphoma, multiple myeloma, and beyond. This is a high-autonomy, high-impact position at the absolute frontier of oncology nursing practice, with responsibility for patients undergoing CAR-T cell therapy, bispecific T-cell engager (BiTE) therapy, clinical trial participation, and standard chemotherapy regimens.
 
 
 
 
 
 New graduates are welcome through the NP1 pathway, making this a rare opportunity to launch an oncology NP career at one of the nation's most prestigious academic medical centers &mdash; with a clear salary progression to $93.81&ndash;$133.97/hour as you grow into the role. A three 12-hour shift schedule means four days off every week, and a comprehensive benefits package includes pension, 401(k), and full medical coverage.
 
 
 
 
 
 
 Key Responsibilities
 
 
 <ul>
 <li>
 Provide comprehensive inpatient management of complex hematologic malignancy patients
 </li>
 <li>
 Oversee patients undergoing CAR-T cell therapy, BiTE therapy, and clinical trial protocols
 </li>
 <li>
 Manage standard chemotherapy regimens and associated treatment planning
 </li>
 <li>
 Identify, monitor, and manage treatment-related toxicities and disease complications
 </li>
 <li>
 Function with high autonomy as part of an interdisciplinary team with attending physicians and fellows
 </li>
 <li>
 Implement Standardized Procedures per California Nursing Practice Act
 </li>
 <li>
 Participate in interdisciplinary rounds and collaborative care planning
 </li>
 <li>
 Maintain accurate and comprehensive inpatient clinical documentation
 </li>
 </ul>
 
 
 
 
 
 Qualifications
 
 
 <ul>
 <li>
 Active California RN and NP license (required)
 </li>
 <li>
 AGACNP board certification required
 </li>
 <li>
 NP1 tier: less than 6 months NP experience &mdash; new grads with relevant RN experience considered
 </li>
 <li>
 NP2 tier: $93.81&ndash;$133.97/hr with experience
 </li>
 <li>
 DEA and CA Furnishing Number required
 </li>
 <li>
 BLS and ACLS certifications required
 </li>
 <li>
 Hematology/oncology NP or RN experience strongly preferred
 </li>
 </ul>
 
 
 
 
 
 Schedule &amp; Compensation
 
 
 <ul>
 <li>
 NP1: $84.62/hour | NP2: $93.81&ndash;$133.97/hour
 </li>
 <li>
 Full-time | Three 12-hour shifts per week
 </li>
 <li>
 4 days off every week
 </li>
 <li>
 Medical, dental, vision, life insurance
 </li>
 <li>
 401(k)/403(b) + pension plan | Malpractice covered
 </li>
 <li>
 Immediate hire
 </li>
 </ul>
 
 
 
 
 🚨
 
 Hiring now! Apply directly here
 
 
 
 
 Or explore 400+ Nurse Practitioner opportunities at:
 
 
 
 
 https://candidate.nphire.com/jobs
 
 
</div>

Nurse Practitioner (3 Day Workweek – $134/hr + Full Benefits – New Grads Welcome)

Explore 19+ Clinical quality coordinator entry in California this May. Find roles across top companies and apply now to boost your career.