Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team. Job Title: Utilization Review Nurse Location(s): Los Angeles, CA Job Description: Ensuring appropriate, cost-effective, and high-quality care for New Century Health Plan members. Conducting utilization management (UM) activities in accordance with health plan policies and regulatory guidelines. Identifying and reporting Potential Quality Issues (PQI) and supporting Provider Dispute Resolution (PDR) processes to ensure compliance and foster provider satisfaction. Completing other duties as assigned. We're seeking a highly qualified candidate with: A BSN or MSN degree, required. Current valid California RN license, required. Two or more years of experience in utilization management, preferably in Medicare Advantage or managed care. Knowledge of Medicare Advantage regulatory guidelines, including CMS regulations. Experience with Potential Quality Issues (PQI) identification and reporting. Familiarity with Provider Dispute Resolution (PDR) processes. Strong clinical assessment and critical thinking skills. Proficiency in electronic health records (EHR) and utilization management software. Excellent written and verbal communication skills. Shift: Day 5x8-Hour (08:00 - 17:00) Ampcus is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veterans or individuals with disabilities. Ampcus
&##128200; Now Hiring: Jr. Financial Analyst Recent Grads Welcome! &##128205; South Jordan, UT | Sandy, UT (Onsite) &##128197; 612 Month Contract | Possible Extension or Perm &##128181; $2324/hour Are you a numbers-driven recent grad ready to jumpstart your...
Summary of Position The Inventory Control Specialist is responsible for ensuring efficient and accurate inventory management throughout the organization. You will be responsible for overseeing inventory control processes, ensuring compliance with company guidelines,...
Job SummaryThe Coeur d'Alene Resort Front Desk Agent represents the first point of contact with guests and handles all stages of a guest's stay.The Front Desk Agent will register/book guests in and out of their rooms, while accommodating special requests. Our Front ...
Ethos Medical Staffing is seeking a travel X-Ray Technician for a travel job in El Paso, Texas. Job Description & Requirements ~ Specialty: X-Ray Technician ~ Discipline: Allied Health Professional ~ Start Date: 06/16/2025~ Duration: 13 weeks ~36 hours per...
About Us Kinn is a modern heirloom jewelry brand built on the belief that luxury should feel personal, effortless, and enduring. With a commitment to responsible sourcing and thoughtful design, we create timeless pieces meant to be worn daily, passed down, and deeply ...