Anchor Staffing, Inc.

Remote Care Review Clinicians - California Residents ONLY There are 3 roles open with differing requirements. M-F 8:00AM- 5:00 PM PST Strong MCG inpatient criteria $38.00 - $43.50 per hour Role 1. - 99-1 Must Haves: SOUTHERN California area Registered Nurse (RN) with a strong background in fraud waste and abuse, to work with MHI SIU on behalf of MCO Healthcare of CA. RN will review CLIA certification documentation from non-participating laboratories. RN may contact the non-participating labs as well as Healthcare of California members. RN will report to SIU leadership on suspected fraud as well as report on non-par labs that have provided appropriate documentation. RN may travel to non-par laboratory locations to inspect that proper equipment exists. RN will also assist with other MCO Healthcare of CA referrals to SIU. Hospice experience Required Role 2. - 00-1 Must Haves: RN will be working daily with CA hospitals, SNF’s, and other lower level of care entities to discharge CA Health Plan members safely to a lower level of care. ? Minimum 5 years of clinical experience as an acute care nurse in med-surg/ tele, ICU or ER setting ? Minimum of 2 years (can be part of the 5 years above) as a hospital based discharge planner for patient discharges to home, SNF, custodial care, LTAC and ARU and an in-depth understanding of what services are available in each of these settings ? Strong understanding of Medi-Cal post-acute care benefits- what is and is not a benefit ? Experience with reviewing and interpreting facility contracts relating to post-acute levels of care (ie. SNF contract language) ? Must demonstrate a high level of accountability to the process of safely, effectively and efficiently transferring members that no longer meet acute care criteria to the most appropriate lower level of care ? Must demonstrate a compassionate communication style with members and providers to create seamless transitions in a member’s care Role 3. 98-1 Must Haves: ? Ideal candidate will have 5+ years of clinical experience as an ICU or ER nurse ? Must demonstrate strong clinical skills in order to decipher the acuity of a member’s HLOC transfer needs ? Inpatient criteria across a broad spectrum of critical care diagnosis ? Must be familiar with IPA’s, delegation, and working with providers. ? Must be able to quickly understand the health plan’s hospital network in order to ensure that PAR hospitals are utilized for HLOC transfers whenever possible ? Experience with repatriation of members back into network. ? Strong communication skills and ability to interact effectively with hospital nurses, attending physicians, hospital administrative staff, and medical directors responsible for transferring and receiving members Kimberly Cameron, PHR Human Resources & Lead, MCO Talent Acquisition Team [email protected] We offer medical insurance and PTO.

Remote Case Manager - California Residents ONLY RN CASE MANAGER- this position is remote but an exception has been provided for the candidate to reside in CA and be a licensed RN in CA. M-F 8:00 AM- 5:00 PM PST $43.00 - $47.00 per hour – Commensurate of experience Job Description: RN’s will be reviewing Hospice related documentation including but not limited to physician orders, Hospice election form and certifications. RN’s will be contacting non-par Hospice providers as well as our client's Healthcare of CA members to coordinate care including loading pseudo authorizations into client's systems. RN’s will report suspected fraud waste and abuse. Must Have Skills: Resident and licensed RN in California RN Hospice experience Hospice background strongly preferred. Health Plan experience preferred. CA licensed, CA based, Registered nurse. Must have a minimum of 3 years Hospice experience. Managed Care and Case Management experience strongly preferred. Day to Day Responsibilities: Roles will review Hospice documentation including physician orders, Member hospice election form, and certifications. Roles will also contact Hospice providers and members on behalf of the CA Health Plan. If documentation is accurate, the roles will load a pseudo authorization in the CA Health Plan’s system. If documentation does not support, Reviewing documentation, contacting hospices and members. Loading pseudo authorizations. Required Years of Experience: 3-5 years Required Licensure / Education: CA licensed RN, Located in CA For immediate consideration: Kimberly Cameron, PHR HR & MCO Talent Acquisition Team 773-881-5743 [email protected] We offer medical insurance and PTO.

Remote MCO Healthcare Program Manager - ILLINOIS RESIDENTS ONLY Must Haves: no exceptions Reside in Illinios Bachelor's in Healthcare Administration, Nursing, Public Health or in a related Healthcare/Behavioral Health-related areas. Managed Care experience preferred but not required. 2 - 4 years of experience. Pay commensurate of experience up to $70.00 per hour. Desired: ? Program Management Professional (PMP) certification is a plus ? Clinical license (RN, LCPC, LCSW etc.) is a plus ? Familiarity with Asana, Microsoft Teams, and Microsoft SharePoint, Advanced level of Excel including Pivot Table, and basic SQL query (this is not IT nor Data Analyst role.) ? Program Management - Healthcare/Mental Health-related ? Process Improvement - Healthcare/Mental Health-related ? Outcomes Management - Healthcare/Mental Health-related ? Data Analytics - Healthcare/Mental Health-related ? Vendor management - Healthcare/Mental Health-related In collaboration with clinical and quality leaders, the Program Manager manages the implementation and administration of population health programs development, supports the state strategic pillars, drives improvements in health outcomes, and strengthens operational initiatives that required under state contract, RFP, or other state/national standards. Reporting to Population Health Officer, the successful candidate will work directly with cross functional teams to ensure deliverables fall within the applicable scope, timeline and budget; coordinate with state, national and internal partners to ensure all programs are designed and delivered to meet goals, measures and outcomes with defined policies, procedures, workflow, training materials and reporting in accordance with corporate, state or other requirements. Please review the must haves and preferences of this role before reaching out. For immediate consideration: Kimberly Cameron, PHR [email protected] 773-881-5743 We offer medical insurance and PTO. NO B2B nor C2C WILL BE CONSIDERED This role will be active for submissions for 48 hours

Remote Clinical Review Nurse RN/LPN – Prior Authorization Illinois Position Purpose: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care. Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: RN/LPN - Licensed Practical Nurse - State Licensure required Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care Coordinates as appropriate with healthcare providers and interdepartmental teams, to assess medical necessity of care of member Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care Assists with service authorization requests for a member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities Collects, documents, and maintains all member’s clinical information in health management systems to ensure compliance with regulatory guidelines Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members Provides feedback on opportunities to improve the authorization review process for members Complies with all policies and standards For immediate consideration: Kimberly Cameron, PHR Human Resources & Lead, MCO Talent Acquisition Team Direct: 773-881-5743 Office: 773-881-0530 [email protected] https://www.linkedin/anchorstaffing.com

Hybrid/Remote Waiver Knowledge RN/LPC/LMSW – IL Wavier Position - Locations: ?** Only these locations will be considered. Chicago Westside Chicago Northside Chicago Northwest Chicago Southside Lake County Dekalb County DuPage County MUST HAVES Three (3) years of Clinical RN experience OR Two (2) years of Licensed Clinical Behavioral Health – LPC or LMSW Reside in one of the locations listed Healthcare or Behavioral Waiver experience SUMMARY This position is responsible for conducting medical management and health education programs for customers on government health care programs. This role will include gathering, analyzing and providing date for regulatory reports. This position will represent the company to members. JOB PURPOSE: This position is responsible for conducting medical management and health education programs for customers on government health care programs. Accountabilities include gathering, analyzing and providing date for regulatory reports. This position will represent the company to members. JOB QUALIFICATIONS: *Registered Nurse (RN), with 3 years direct clinical care to the consumer in a clinical setting or Licensed Professional Counselor (LPC), or Licensed Master Social Worker (LMSW), which includes 2 years of clinical practice to obtain their LPC or LMSW license. * Current, valid, unrestricted license in the state of operations (or reciprocity). For compact licensee changing permanent residence to state of operations, you must obtain active, unrestricted RN licensure in the state of operations within 90 days of hire. * Plus 3 years wellness or managed care experience presenting clinical issues with members/physicians. * Knowledge of the health and wellness marketplace and employer trends.* Verbal and written communication skills including discussing medical needs with members and interfacing with internal staff/management and external vendors and community resources.* Analytical experience including medical data analysis.* Current driver's license, transportation and applicable insurance.* Ability and willingness to travel within assigned territory.* PC proficiency to include Word, Excel, and PowerPoint, database experience and Web based applications. PREFERRED JOB QUALIFICATIONS: Bilingual in English and Spanish. * Transition of Care experience. * Experience in managing complex or catastrophic cases. * Certification in Case Management, Training, Project Management or nationally recognized health care certification. For immediate consideration: Kimberly Cameron, PHR Human Resources & Lead, MCO Talent Acquisition Team Direct: 773-881-5743 Office:?773-881-0530 https://lnkd.in/gNSmSNCA??

Chicago Minority Supplier Development Council 2024 Annual Holiday Brunch ??

Chicago Minority Supplier Development Council. MBEIC Minority Business Enterprise Input Committee General Meeting.

The University of Chicago 16th Annual Professional Services Symposium.

Care Review Clinician - California RN's only 100% remote What is the typical schedule/shift going to be (i.e., 8am – 5pm)? 8-1700 or 830 – 1730 or 9-1800 PST Job Description: MCO client Healthcare Services works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service. Must Have Skills: ? Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines. ? Analyzes clinical service requests from members or providers against evidence based clinical guidelines. ? Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. ? Conducts inpatient reviews to determine financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. ? Processes requests within required timelines. ? Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner. ? Requests additional information from members or providers in consistent and efficient manner. ? Makes appropriate referrals to other clinical programs. ? Collaborates with multidisciplinary teams to promote Molina Care Model. ? Adheres to UM policies and procedures. Day to Day Responsibilities: ? Clearing discharges using UMK2 and EMR access ? Admission and continued stay reviews ? Processing NON PAR and Eligibility Reviews ? Completing reviews per Sharp/SCRIPPS/DIGNITY PROCESS ? Internal Reconsideration reviews ? Peer to Peer Follow Up ? Reconsideration Follow Up ? Processing denials and requesting letters ? Reviewing DOFR for financial responsibility ? Disenrollment for members that expire ? Following Hospital Assignment Grid / MD Coverage List Required Years of Experience: 1 Year Med Surg Required Licensure / Education: CA RN/LVN License For immediate consideration send updated resume to Kimberly Cameron, PHR Human Resources & Lead, MCO Talent Acquisition Team [email protected] 773-881-5743

Job Title- Sr. Provider Data Analyst – Fully Remote NO B2B or C2C Work hours M-F 8-5pm EST Contingent to Permanent – Eligible after 90 days $38.00 - $42.00 per hour– pay rate commensurate of experience 2-5 years of experience ***Experienced user of Quest Analytics and management of GEO*** Responsible for accurate and timely identification of critical information on configuration and claims databases. Maintains critical knowledge on configuration and claims databases. Oversees operational and claims systems and application of business rules as they apply to health plan. Validates data to be housed on databases and ensures adherence to business and system requirements of health plan as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. ?Analyze and interpret data to determine appropriate configuration changes. ? Accurately interprets specific state and/or federal benefits, contracts as well as additional business requirements and converting these terms to configuration parameters. ? Oversees coding, updating, and maintaining benefit plans, provider contracts, fee schedules and various system tables through the user interface. ? Applies previous experience and knowledge to research and resolve claim/encounter issues, pended claims and update system(s) as necessary. ? Works with fluctuating volumes of work and can prioritize work to meet deadlines and needs of user community. ? Provides analytical, problem-solving foundation including definition and documentation, specifications. ? Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements. ? Reviews, researches, analyzes, and evaluates all data relating to specific area of expertise. Begins process of becoming subject matter expert. ? Conducts analysis and uses analytical skills to identify root cause and assist with problem management as it relates to state requirements. ? Analyzes business workflow and system needs for conversions and migrations to ensure that encounter, recovery and cost savings regulations are met. ? Prepares high level user documentation and training materials as needed. ? Works to identify opportunities for continuous improvement, standardization, and reduction of rework across health plan and shared services ? Monitors, coordinates, and communicates the strategic objectives of health plan across shared services to optimize performance/results. ? Aggregates and assists with the analysis of health plan and shared service data. ? Bachelor’s Degree or equivalent combination of education and experience ? 1-3 years formal training in Business Analysis and/or Systems Analysis For immediate consideration: Kimberly Cameron, PHR Lead, MCO Talent Acquisition Team Direct: 773-881-5743 – M – F 9 am – 4 pm CST? LinkedIn:?https://lnkd.in/gNixuveK?