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Iehp Rn Jobs in California (NOW HIRING)

SAC Health

ECM Care Manager, RN

San Bernardino, CA · On-site

The RN will maintain a broad perspective of patient care by identifying and evaluating patient ... Communicates with other case managers/program managers i.e. (IEHP), health professionals and ...

SAC Health

ECM Care Manager, RN

San Bernardino, CA · On-site

$46.20 - $60.05/hr

The RN will maintain a broad perspective of patient care by identifying and evaluating patient ... Communicates with other case managers/program managers i.e. (IEHP), health professionals and ...

SAC Health

LVN Message Center

San Bernardino, CA · On-site

$32.39 - $38.86/hr

... RN to maintain an effective operation in the Message Center. Answers high volume of calls and ... CDPH, FPACT, IEHP, Medi-Cal, etc.) Maintains clean, orderly, and well-maintained work area.

SAC Health

Message Center, LVN

San Bernardino, CA

$28.25 - $38.25/hr

... RN to maintain an effective operation in the Message Center. Answers high volume of calls and ... CDPH, FPACT, IEHP, Medi-Cal, etc.) Maintains clean, orderly, and well-maintained work area.

SAC Health

Message Center, LVN

San Bernardino, CA · On-site

$28.25 - $38.25/hr

... RN to maintain an effective operation in the Message Center. Answers high volume of calls and ... CDPH, FPACT, IEHP, Medi-Cal, etc.) Maintains clean, orderly, and well-maintained work area.

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Iehp Rn information

What is an IEHP RN job?

An IEHP RN (Registered Nurse) works for Inland Empire Health Plan (IEHP), a managed care organization that provides healthcare services to Medicaid and Medicare beneficiaries. Their role typically includes case management, utilization review, care coordination, and patient education to ensure members receive appropriate and effective healthcare services. They collaborate with healthcare providers, social workers, and patients to develop and implement care plans. The goal of an IEHP RN is to improve health outcomes by promoting preventive care, managing chronic conditions, and ensuring efficient use of healthcare resources.

What are the typical day-to-day responsibilities for an IEHP RN?

As an IEHP RN, much of your day involves coordinating member care, conducting telephonic or in-person assessments, creating and updating care plans, and collaborating closely with healthcare providers, social workers, and support staff. You will frequently review medical records, provide patient education, and help ensure members receive appropriate resources and services. Working as part of a multidisciplinary team, you play a critical role in improving member health outcomes and helping members navigate the healthcare system. The work combines both independent tasks and regular team collaboration for integrated, patient-centered care.

What are the key skills and qualifications needed to thrive in the Iehp Rn position, and why are they important?

To thrive as an IEHP RN (Registered Nurse at Inland Empire Health Plan), you should have an active RN license, strong clinical judgment, and experience in case management or care coordination. Familiarity with health plan software systems, electronic health records (EHR), and certifications such as CCM (Certified Case Manager) or managed care nursing credentials are beneficial. Outstanding communication, critical thinking, and the ability to work compassionately with diverse populations are key soft skills. These qualifications ensure efficient and quality care coordination for members while meeting compliance in a managed healthcare setting.

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What job categories do people searching Iehp Rn jobs in California look for? The top searched job categories for Iehp Rn jobs in California are:
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Iehp Rn jobs near you

Provider Quality Review Nurse, RN

Inland Empire Health Plan

Rancho Cucamonga, CA

Other

Medical, Dental, Vision, Life, Retirement

Posted 4 days ago

Key responsibilities

  • Investigate and complete case summaries and make recommendations for Potential Quality of Care Incidents referred to the Quality Management department.

  • Maintain direct communication with internal departments, external facilities, and providers to ensure all PQI issues are thoroughly investigated and care is coordinated in a timely manner.

  • Complete data entry into database systems and maintain updated documentation and tracking mechanisms for all cases.

Job description

Overview

This is a short-term assignment.  

What you can expect! 

Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience!

 

At Inland Empire Health Plan (IEHP), we believe the highest quality of care should be delivered to all in the Inland Empire.  We are thinking beyond the way Quality is viewed today - we believe it should be holistic and transformative.  IEHP's provider incentive programs serve an important role in achieving IEHP's quality goals.

Reporting to the Manager of Provider Quality Oversight, the Provider Quality Review Nurse, RN is responsible for:

  • Receive and research all PQI and QR cases as assigned, provide a summary and recommendations to the Medical Director of case assignments
  • Effectuate all action items as determined by the Medical Director to resolution of case assignments
  • Reviewing escalated issues
  • Discussing and reviewing cases with Medical Directors referred to the Quality Management (QM) department
  • Investigation of cases includes, but not limited to, the documentation of case summaries, follow up actions, outreach efforts, and communications in the QM database

Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Additional Benefits

Perks

 

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

  • Competitive salary.
  • Hybrid schedule.
  • CalPERS retirement.
  • State of the art fitness center on-site.
  • Medical Insurance with Dental and Vision.
  • Life, short-term, and long-term disability options
  • Career advancement opportunities and professional development.
  • Wellness programs that promote a healthy work-life balance.
  • Flexible Spending Account - Health Care/Childcare
  • CalPERS retirement
  • 457(b) option with a contribution match
  • Paid life insurance for employees
  • Pet care insurance
Key Responsibilities
  • Investigate and complete case summaries and make recommendations for any Potential Quality of Care Incidents (PQI) referred to the QM department.
  • Maintain direct communication with IEHP departments, external facilities including hospitals, Skilled Nursing Facilities, and/or Providers to ensure all PQI issues are thoroughly investigated, and care is coordinated in a timely manner, as needed.
  • Review requested medical records to ensure complete case documentation is received from all practitioners, providers, and entities/agencies to ensure thorough investigation of the issue.
  • Review case findings and recommendations with Medical Director. Issue Corrective Action Plans (CAP), review CAP responses, draft Opportunity for Improvement letters, and coordinate other interventions as needed to ensure all issues were addressed and future occurrences of the same issue are mitigated.
  • Complete data entry into database systems, maintain updated documentation and other tracking mechanisms for all cases.
  • Review and execute ad hoc requests, quality reviews, and/or focused audits, as needed.
  • Escalate issues of non-compliance to the Quality Systems Management team.
  • Maintain working knowledge of regulatory requirements as they relate to QM operations and protocols.
  • Complete other tasks and assignments based on department and business needs.
  • Demonstrate a commitment to incorporate LEAN principles into daily work.
    • Qualifications

    Education & Requirements 

    • Three (3) or more years of any individual or combined healthcare experience in quality assurance, quality management, quality improvement, utilization management, discharge planning, and/or case management
    • Three (3) or more years of work experience in a managed care, hospital, provider practice, or other comparable healthcare experience
    • Experience preferably in a quality/performance improvement setting
    • Bachelor's degree in Nursing from an accredited institution required
      • In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position
      • This experience is in addition to the minimum years listed in the Experience Requirements above
    • Certified Professional in Healthcare Quality (CPHQ), Certified Professional in Healthcare Risk Management (CPHRM), or Clinical certification in area specialty) preferred
    • Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required

    Key Qualifications

    • Must have a valid California Driver's License
    • Excellent understanding of performance improvement, quality assurance, and utilization management
    • Knowledgeable in clinical analysis of health records, assessing or evaluating quality, and identifying problems or issues with care delivery
    • Microcomputer applications: spreadsheet, database, and word processing
    • Excellent written and verbal communication skills
    • Excellent coordination skills
    • Ability to communicate findings and form recommendations based on clinical case reviews
    • Ability to demonstrate critical thinking, strong problem-solving capability. Strong attention to detail
    • Ability to prioritize work to ensure adherence to project deadlines. Ability to effectively escalate issues as identified, following established protocols
    • Positive attitude and ability to work in a team setting
    • Self-direction and ability to work with minimal supervision
    • Word processing and data entry involving computer keyboard and screens, automobile travel within the Inland Empire
    • Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval

    Start your journey towards a thriving future with IEHP and apply TODAY!

    Work Model Location

    Telecommute (All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership)

    Pay RangeUSD $91,249.60 - USD $120,910.40 /Yr.Employment Type: OTHER

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