About Us Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of eight hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees. Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans. We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come. Job Description Type of Opportunity: Per Required Need FTE: 0.001000 Exempt: No Work Schedule: Days Location: Presbyterian Santa Fe Medical Center Education: Essential: Associate Degree Education specialization: Essential: Respiratory Therapy Credentials: Essential: Reg Resp Therapist (NBRC) Respiratory Care Practcnr-NM License Other information: Two to three years college level courses/Associates Degree/Diploma in Respiratory Care. New Mexico Respiratory Care Practitioner License, Registered Respiratory Therapist credential from the NBRC, ACLS and/or PALS , BLS required. Six months to one year critical care experience preferred Competencies and skills: Essential: BLS Nonessential: SKILL-Ability to effectively interact with customers to understand their needs and explain data SKILL-Microsoft Office Planning and coordinating organizational change Anticipating & Addressing Customer Needs Educating Employees, Customers & Transferring Knowledge Functioning as an Effective Contingent Member Acquiring & Applying Superior Skills to achieve Quality Outcomes Functioning as an Effective Team Member SKILL-Demonstrated ability to communicate effectively in person and via telephone with members, employer groups, brokers, physicians, and physician office staff using strong dialogue and customer service competencies. SKILL-Written communication Summary: Provide routine and advanced respiratory care responsibilities, manage ventilators, implement cardiorespiratory protocols, and perform advanced airway care Benefits Benefits are effective day-one (for .45 FTE and above) and include: Competitive salaries Full medical, dental and vision insurance Flexible spending accounts (FSAs) Free wellness programs Paid time off (PTO) Retirement plans, including matching employer contributions Continuing education and career development opportunities Life insurance and short/long term disability programs About New Mexico New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great. Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC. New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
Are you customer focused, personable, resourceful and looking to start your career with a leading provider in customized promotional marketing, advertising, sales and brand marketing strategies? We ...jobs by
About Us Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of eight hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state’s largest private employer with approximately 11,000 employees. Presbyterian’s story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans. We are part of New Mexico’s history – and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come. Job Description Type of Opportunity: Full Time FTE: 1.000000 Exempt: No Work Schedule: Days Location: PMG - Santa Fe St Michaels Education: High School Diploma or GED Other information: Academic Preparation: High school or equivalent Short-term training in Medical Terminology Familiarity with CPT and ICD-10 coding Experience: Minimum 18 months experience in a medical office setting with significant MD interaction Proficiency in prior authorization/certification/referral process Must pass EPIC competency for Registration at completion of Epic Clerical Training class Professional Requirements: Pass annual competency exam for all areas of responsibility. Attend Quarterly MSO meetings. Attend Staff meetings Attend Employee Forums Abilities: Requires strong organizational and multi-tasking skill sets Significant customer service skill set paramount Must be able to function under pressure while maintaining professionalism Working knowledge of CPT and ICD-10 coding Pass annual competency exam for all areas of responsibility. Attend Quarterly MSO meetings. Attend Staff meetings Attend Employee Forums Summary: Performs visit closure activities to coordinate patient care while providing an exceptional patient experience for successful completion of next steps ordered by the clinician Advanced scheduling for specialty or radiologic procedures Recognizing payor requirements and obtaining prior authorization/certification/referrals for visits/procedures Processes daily referral workqueues for authorization, deferring only those that require payor consideration Primary Care and most Specialty Care offices must process STAT and ASAP referral workqueues for results received Return scheduling knowledge to include the ability to scrub schedules for accuracy and efficiency in home department Monitor in-baskets and reports for overdue results, waitlisted appointments, recalls, etc Benefits Benefits are effective day-one (for .45 FTE and above) and include: Competitive salaries Full medical, dental and vision insurance Flexible spending accounts (FSAs) Free wellness programs Paid time off (PTO) Retirement plans, including matching employer contributions Continuing education and career development opportunities Life insurance and short/long term disability programs About New Mexico New Mexico’s unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque’s International Balloon Fiesta, Los Alamos’ nuclear scientists, Roswell’s visitors from outer space, and Santa Fe’s artists, and you get an eclectic mix of people, places and experiences that make this state great. Cities in New Mexico are continually ranked among the nation’s best places to work and live by Forbes magazine, Kiplinger’s Personal Finance, and other corporate and government relocation managers like Worldwide ERC. New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it’s all available among our beautiful wonders of the west. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
Customer Service, Sales & Management Openings * Do you enjoy being out and about vs. in a cubical? * Do you have Great People Skills and want an EXCITING NEW CAREER? * Are you tired of talking on the ...jobs by
DISHWASHER Grow your career with MERRILL GARDENS!!Merrill Gardens, a privately-owned family company with a proud history of success is currently hiring a Dishwasher at Merrill Gardens at Rockridge in Oakland, CA. Apply now to join one of the most respected senior living operators in the country! Yes, You CAN have a meaningful Career!Watch This! We offer our employees:Highly competitive pay and benefits!Benefits include medical, dental, vision, 401(k), paid vacation, holidays, and more!!Daily complimentary meals!Most evenings off! Our kitchen closes at 7:00! You'll be done by 8:00!A rapidly growing company with opportunities for advancement!Company sponsored training!If you are someone with:Food Handler s Permit as requiredFlexibility with schedule and availability to work early morning and evening shifts as well as weekends and holidays We want to talk with you!Consider applying to become a Dishwasher with Merrill Gardens! Our Dishwashers are responsible for:Washing all dishes and assist cooks in preparation of the breakfast, lunch, or dinner meals.Complete all cleaning duties on a daily, weekly and monthly schedule.Handle all foods, storage and cleaning activities in accordance with federal, state and local procedures. Named Number Six of FORTUNES 50 Best Workplaces for Aging Services!Merrill Gardens was recognized as 2016 Family Business of the Year!Our mission is to provide an inspiring environment for our residents, families, and team members where every life is defined by the possibilities.If you are a team focused individual with a deep commitment to customer service, please start the online application process to become part of the Merrill family!Merrill Gardens is an Equal Opportunity EmployerJB.0.00.LN Associated topics: clean, cleanliness, dishwasher, dishwasher steward, lavavajillas, limpieza de cocina, service assistant, stewarding, stock, wash
The Government Outreach Associate will ensure accurate and timely collection and analysis of the Federal Life Line Program data for monitoring progress towards meeting goals and reporting to agency ...jobs by
Job Description Looking for a rewarding job opportunity with meaning and purpose? Make 2019 a year of positive change.Apply to Teach For America and help shape the future of our country.Who We Are Teach For America (TFA) is a leadership development organization focused on the systemic challenges facing children growing up in poverty.While potential is equally distributed across lines of race and class, opportunity is not, and we seek to correct this injustice.We recruit, train, and support t
Customer Service Representative Job Purpose: Attract and Serve customers by providing product and service information through community outreach and marketing promotions! Do you want to be a manager ...jobs by
TRUCK DRIVERS - REGIONAL AND OTR CLASS A CDL DRIVERS Guaranteed Transition Pay NEW ANNUAL PAY INCREASE - Earn an Average of $3,000 - $7,500 more per year! LCL Bulk is a Wisconsin based food grade tanker company that primarily hauls liquid chocolate for some of the largest chocolate manufactures in the US! LCL is expanding and is adding drivers to run regionally and OTR.Drivers for LCL can expect: Average of between $1,200 TO $1,500 PER WEEK $1,200 / week Guaranteed Transition Pay for 90 days st
Candidates must possess integrity, character and exemplary ambition for success. The Customer Service Representative position is considered an entry level position, meaning thorough training is ...jobs by
Job Description * Upcoming Deadline: Friday, February 1st, 2019.Who We Are Teach For America (TFA) is a leadership development organization focused on the systemic challenges facing children growing up in poverty.While potential is equally distributed across lines of race and class, opportunity is not, and we seek to correct this injustice.We recruit, train, and support talented and ambitious leaders from all career backgrounds and academic majors to teach in high-need communities across the
Customer Service TITLE Agent **$11.25/hr** **FLIGHT BENEFITS** WE ALSO RECOMMEND EOE We are an equal employment opportunity STATEMENT employer. All qualified applicants will receive consideration for ...jobs by
New drivers are now eligible for $2,500 in sign-on incentives! TransAm Trucking is now hiring company CDL-A truck drivers for long-haul career opportunities! Apply today and enjoy life on the road with competitive pay, top-of-the-line equipment and plenty of great driver rewards: TransAm Trucking Company Truck Drivers Enjoy: 32 cents per mile loaded and empty (includes per diem) $2,500 Sign-On Bonus $100/month retention bonus after one year of continuous service $50 Layover Pay $20 Per Pickup/st
Do you pride yourself on your top-notch people skills? Are you a people person who loves working with the public? Our client wants to meet you! The Job Window is seeking a full-time Customer Service ...jobs by
Registered Nurse. Travel Nurse Associated topics: ambulatory, care unit, intensive, intensive care, mhb, nurse clinical, recovery, registed, surgery, transitional
OPORTUN is currently seeking qualified candidates to work Full-Time with Customer Service or Cashier or Sales or Hospitality experience in Oakland,CA! If interested after reading my entire post ...jobs by
Final Deadline Alert: Applications should be submitted no later than Friday, March 1st, 2019.Who We AreTeach For America (TFA) is a leadership development organization focused on the systemic challenges facing children growing up in poverty. While potential is equally distributed across lines of race and class, opportunity is not, and we seek to correct this injustice. We recruit, train, and support talented and ambitious leaders from all career backgrounds and academic majors to teach in high-need communities across the US.No matter your career background or academic major, we believe that your unique experiences and skills can play a vital role in ensuring that kids in high-need communities receive a quality education.Who You AreJoining Teach For America is a great fit if: You have a deep-seated belief that every child in America should have access to an excellent education and equal opportunity to learn and grow, regardless of race, ethnicity, location, or socio-economic background. You have a desire to build stronger communities and empower future generations. You have proven leadership experience and a history of achievement. You are hungry for a job where you can make a difference and help create enduring change.What You ll DoWe recruit outstanding and diverse leaders to become corps members. As a corps member, you ll be a full-time teacher for two years at the preschool, elementary, middle, or high school level, with the opportunity to lead real change and make a deep impact on your students and the community that you serve.Teach For America corps members teach a variety of subjects, including (but not limited to): science, math, computer science, humanities, language arts, English, reading, special education, Spanish/bilingual education, ESL, history, social studies, and more.You ll work in close partnership with educators, parents, and community members to set ambitious goals for your students and help support them on their journey to achieving their dreams. With an unparalleled support network, ongoing coaching and leadership development during your two years in the corps, you will have a profound impact on your students academic and personal growth. As a TFA alum, you will gain access to numerous top graduate school and employer partnerships that will help you advance and accelerate your leadership trajectory after you leave the corps.While many alumni choose to continue teaching after their two year commitment, others choose to branch out across a variety of sectors law, non-profit, finance, government, and more while continuing to help positively impact the movement for educational equity throughout their careers.We are Educators. Mentors. Leaders. Community Members. Together, we see the potential in each and every student in this country no matter what.Where You Will TeachTeach For America works in 51 communities across the country. We call them regions, and they range from large cities to rural communities, from New Haven to Hawai'i and South Dakota to the Rio Grande Valley, TFA corps members are challenging what is possible for our nation s students.Minimum Requirements Strong academic performance: Minimum cumulative 2.5 GPA or higher Bachelor s degree by June 2019 or earlier Must be a citizen, national, or legal resident of the United States or have DACA statusFinal Application DeadlinePlease submit your completed application before the upcoming deadline date: 3/1/19 Associated topics: administrative coordinator, administrative support, database administrator, executive assistant, executive support, management support, operational support, recruitment, salesforce, staff assistant
Vivid is actively searching for a Customer Service Representative. At Vivid, you will work side by side with an energetic team that hosts product launches, pop-up shops, and trade shows at retail ...jobs by
The Job As a driver, you are the polite and friendly face that takes Pizza Hut to the customer's door. You're it. You're us out 'there'. You're part of why we're the team that's famous for a reason. The Perks The hours are flexible. You're out and about, listening to tunes and delivering great pizzas. Ohand people are really, really happy to see you What we look for Besides being a team player who enjoys working in a fast-paced environment, there are other things that will help you be a successful Pizza Hut driver. You're friendly (with a great smile) You value customers You've got a good sense of directionor GPS You've got a reliable car A current driver's lisence You take pride in your appearance You've got loads of energy And you like to be on time You also always keep in mind our work standards around cleanliness, hospitality, product and speed of service. Our customers are important to us, and we'll give you all the training you need to provide them with the great service they've come to expect from the team that's famous for a reason. This Summary Overview generally describes key job duties . It is not all-inclusive
Location: Oakland, CA Employment Qualifications include * Excellent communication skills, via phone, email and text * Previous experience in call center and or office administration a real plusjobs by
This role can be remote, located anywhere in the continental US We are unable to sponsor for this permanent full-time role Prestigious Enterprise Company is currently seeking a Lead Cyber Security Operations Engineer. Candidate will lead maturity efforts to implement the security operation and platforms process and technology road-map Candidate will be proactively identifying, recommending, implementing, maintaining and configuring key security technologies and initiatives. Candidate will lead ther management of all Security tools, executing the Security Incident Response process for any alerts or events found within their tools set or from additional sources as well as identifying and scoring risk related to the Enterprise. Responsibilities: Proactively identifies gaps, makes plans, implements, updates, maintains, manages, monitors, and supports enterprise Security Tools. Leads change control and device configuration management activities on all security technologies Identifies the need for and provides management level reporting of all critical intrusion or vulnerability detection tools. Invokes the security incident response process including security response team activities as well as providing and implementing tactical risk mitigation to incidents Actively protects the availability, confidentiality, and integrity of customer, employee, and business information Helps to lead in the Risk Assessment Program including identifying and scoring risk. Provides vulnerability and threat management monitoring and mitigation response Helps to lead in tactical and operational planning of vulnerability assessment activities Contributes to Enterprise security team effectiveness by accomplishing additional security related results as needed Mentors Senior and Lead Security Engineers in the review, development, testing and implementation of security plans, products and control techniques Helps to lead the execution of projects and initiatives Participates in operations and tactical planning Can act as a backup for the Security Operations manager in non-HR related scenarios Manage individual workload to deliver to agree upon project milestones Influence result driven tasks within the IS Security Team to complete successfully on time and on budget Qualifications: College degree in related technical/business areas or equivalent work experience required. 10years relevant work experience preferred. Solid understanding of technology, operations and key business processes. Member of SANS or other leading security organizations preferred. Proven change management skills. Highly flexible and able to adapt to change. At least two (2) of the following Industry certificates CEH, CISSP, or OCSP required. Influencing and negotiation skills. Solid understanding of UNIX / Linux operating systems. Solid Understanding of the common Unix and Windows utilities, diagnostic and monitoring tools. Scripting experience with Perl, Shell and/or Java. Strong verbal and written communication skills. Strong organizational and interpersonal skills. Strong team player with proven collaboration skills. Strong critical thinking and problem solving skills. Proven change agent who consistently delivers results. Solid understanding of network protocols, LAN, WAN, SSL, Firewall, Load Balancer, and DMZ configurations. Understanding of the PCI (Payment Card Industry) data security standard and other regulatory concerns (SOX, FCRA, FISMA, etc.). Technical Skills: Information Risk Management: Content filtering technologies, application firewalls, vulnerability scanners, LDAP, SAML, forensics software, and security incident response. O/S: Linux (Red Hat, SUSE), Windows Desktop (XP, Win7, and Win10) and Server (2000, 2003, 2008, and 2012), and UNIX (HP/UX, AIX, etc). Network: Firewall and Switching technologies (Cisco ASA, Juniper SRX, Checkpoint, etc) OSI Model, VPN, IDS/IPS, Proxy/Reverse Proxy, WAF, Two Factor Authentication, RADIUS, Netflow, Anti-SPAM, and Vulnerability Scanning/Reporting (Qualys, Rapid7, Nessus, NMAP, etc.…). Software Languages: Perl, PowerShell, Python, and SQL. End Point: Anti Malware, HIPS, Client based firewall, Whitelisting/Blacklisting technologies, GPO, WMI, and BASH. - provided by Dice Lead Cyber Security Operations Engineer
We are looking for a Field Service Representative to make a positive impact on our business, and their career. Our Field Team Leaders oversee our Sales Representatives at various locations across the ...jobs by
Details: Local dedicated opportunity Cheyenne, WY to Rock Springs, WY Home Daily $2,000 relocation bonus available for those who qualify Werner Enterprises realizes that Drivers have diverse needs, and that this diversity requires flexible support. Our goal is to offer a customizable package that can be tailored to the specific needs of each individual and their family. Medical/Dental Vision Basic life insurance Optional Benefits 401(k) Retirement Plan Employee Assistance Program Tuition Reimbursement - Up to $15,000 Military Apprenticeship Program Stock Purchase Plan Onsite Fitness Facilities Onsite Recreation Facilities Why Drive Werner? Why Werner? There are many great advantages to driving with Werner Enterprises. Besides the comprehensive package of benefits (Health, Dental and Vision Insurance, 401(k) Retirement Plan, and Stock Purchase Plans) offered to Werner Drivers, there is the peace of mind knowing that you are working with a company that is well established and in strong financial condition with low debt. In a time where financial uncertainty plagues many companies, Werner Drivers have confidence in knowing that they will be paid on time and are part of a team that values their needs. Werner Enterprises was founded by a driver, for drivers. The company operates a fleet of more than 7,300 trucks and more than 24,000 trailers throughout the U.S., Mexico and Canada. This allows our drivers the flexibility of driving for a service that suits their lifestyles, with the added benefit of living in any area of the country. As a Werner driver, you receive personal attention and your fleet manager gets to know you by name. Werner Enterprises offers many opportunities for drivers, nationally and regionally within the various Van, Flatbed and Temperature Controlled services. If you would like more information on this position, please call our recruiting department at (877) 783-9671 or visit our website at www.drivewerner.com. No Touch Freight
Job Summary: This position is based in Galt, CA. This is not a remote position. The Salesforce Administrator will lead the ongoing development of our Salesforce platform deployment. A successful ...jobs by
Genesis is one of the nation's leading providers of post-acute healthcare services from short-term to long-term care and a wide variety of living options and professional clinical services. We are changing how care is delivered by bringing together people like you passionate - highly skilled and motivated to make a difference. The Registered Nurse (RN) is a vitality specialist that helps change the lives of patients and residents each day. An RN is responsible for providing a full range of nursing care in an interdisciplinary environment including: Assessment Care Planning Implementing Care Managing Patient Care Quality Improvement Problem Solving Beside Nursing Medication Administration Treatments NRN1 QUALIFICATIONS: REQUIREMENTS: A graduate of an approved school of nursing is required and must be currently licensed by the State Board of Nursing CPR Certification One to three years of experience working as a RN in a related setting is preferred. Position Type: Part Time Req ID: 300251 Center Name: Casa Real Center
Customer Service Associate Here's to providing a personal service that's second to none. As a Customer Service Associate for Gamree, you'll be there for every new and existing customer who has ...jobs by
Class A CDL and 6 months OTR experience required Drive for the nation's largest for-hire, temperature-controlled carrier in the Midwest. Generous Pay Packages Medical Benefits. Apply here.
Customer Service Representative (Import/Export) - Oakland, CA Coordinate and manage all functions in regards to customer service, daily workflow, communication, billing and documentation for assigned ...jobs by
Job Description : Working at Pizza Hut® is about making hungry people happy. It's about being independent and having fun, making new friends and earning extra cash. If you're ready to take the next step in your career in restaurant management, our Shift Manager position is the right place to do it. Working as a Shift Manager will let you develop your management skills while still having the time to do the things you enjoy. You'll benefit from our training and career opportunities and receive reward and recognition for your efforts. What are we looking for? The good news is that your training will teach you everything you need to know to succeed on the job. But there are a few skills you should have from the get-go: We have a great culture at Pizza Hut and look for people with a similar mindset. You're the honest, energetic and approachable type; able to get along and communicate easily with people at all levels. You're never short of a smile and take real pride in your work; cope well under pressure and thrive on a challenge. A natural leader, you sincerely value customers and champion teamwork. You're all about teaching new things and motivating the team to work together. You set high standards for yourself and the people you work with – you love keeping things clean, safe and fun for the team and the customers You want to learn how to run great restaurants from the best restaurant managers in the business And, you're at least 18 years old with a valid driver's license, reliable transportation (not public transportation – you may need to drive to make deposits for the restaurant sometimes) and a true desire to learn and grow. This Summary Overview generally describes key job duties . It is not all-inclusive
Position Summary : Responsible for coordinating administrative, business and other operational activities such as, but not limited to, HR, payroll, A/P, scheduling direct service staff and resolving ...jobs by
Highland's Care Management is looking for supertars to join the team SUMMARY: Coordinates and executes the appeal process for all AHS facilities clinical appeals and third party audits. DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE : The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification. Actively participates in department meetings and operations including process development or improvement. 2. Assures clinical interventions are appropriate for the admitting diagnosis and reflect the standard of care, as defined by the medical staff and the organization; utilizes clinical knowledge and defined standards of care to proactively identify inappropriate admit status based on identified criteria and ensures the patient is registered at the appropriate level of care; Utilizes McKesson Interqual® clinical guidelines; refers questionable cases to the CM Manager or physician advisor for determination. 3. Collaborates and communicates regularly with contracted Health Plans, Medical/Provider Groups, ancillary vendors, industry wide organizations (i.e. Department of Managed Health Care, Alameda County Health department, California Children's Services), internal departments and any other providers when appropriate. 4. Communicates with physicians and multidisciplinary health team members to maintain the multidisciplinary team approach to ensure effective resource utilization and appropriate level of care. 5. Coordinates all utilization review functions, including response to payor requests for concurrent and retrospective review information including Medicare and MediCal regulations/requirements; ensures the appropriate level of care is assigned and documented on all patient medical records. 6. Coordinates with Care Management team when cases do not meet criteria; coordinates denials with the attending physician and the Care Management physician advisor; prepares case reports; documents treatment plan, progress notes and discharge summary related information as required by Medicare, MediCal, Title 22 and other mandated regulations according to Department standards. 7. Develops, collects, trends and analyzes data relevant to the utilization of healthcare resources including but not limited to avoidable/variance days, readmissions, one-day stays, DRGs, LOS. 8. Ensures all applicable department and regulatory targets for productivity and department performance process improvements in the area of denials are attained (e.g., readmissions, throughput, LOS). 9. Identifies and documents quality incidents. 10. Initiates the appeal process, at the direction of the Supervisor and/or physician advisors, until the case is overturned, appeal options are exhausted or decision is made to discontinue process; assumes the responsibility for coordinating and appealing clinical denials per department policy; develops any appeal letters to substantiate the medical necessity for admission or continued stay using evidence from the medical record and clinical review tools, as well as input from the attending physician and/or Physician Advisor, complies with all submission time frames and other guidelines outlined by the third party payers and auditors. 11. Perform all other duties as assigned. 12. Performs utilization concurrent and/or retrospectively reviews all the patients in caseload in the following areas: admission criteria for medical necessity and appropriateness of care, continued stay criteria for medical necessity and appropriateness of care, Resource Management issues, other issues including concerns involving under/over utilization, avoidable days and quality issues. 13. Responsible for all incoming and outbound clinical requests, questions, concerns and complaints. 14. Tracks and trends progress and outcomes of denial and appeal processes and compiles reports for division and AHS leadership. MINIMUM QUALIFICATIONS: Preferred Education : Master's in Nursing. Preferred Licenses/Certifications : Certification in Case Management, CCMC or ACM. Required Education : Bachelor's of Nursing, Required Experience : Five years of acute care nursing including medicine/surgery, ICU, telemetry or Five years of Case Management experience in an acute setting or utilization review at a medical group or health plan. Required Licenses/Certifications : Active licensure as a Registered Nurse in the State of California, Active BLS - Basic Life Support Certification issued by the American Heart Association. Other advanced life support certifications may be required per unit/department specialty according to patient care policies. CPI -Crisis Prevention Intervention Training (required for all positions at John George Psychiatric Pavilion; and certain positions in the Emergency Department).