Regulatory Nurse Case Manager

Job not on LinkedIn

🕒 6 days ago

🏄 California – Remote

🏄 California – Remote

💵 $35 - $40 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚔 Compliance

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MedPOINT Management

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1988

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

MedPOINT Management is a California-based healthcare management services organization that supports independent practice associations (IPAs), provider networks, hospitals and contracted health plans with clinical quality, care management, administrative operations and technology solutions. For more than 32 years MPM has provided services including provider network operations, case management, utilization management, claims operations, credentialing, HEDIS/STARs quality measurement and analytics (via Cozeva), call center and financial management, and digital provider portals and resource libraries. The company emphasizes data security and compliance (SOC 2 and HITRUST e1 certifications for its EZ-CAP and Provider Web Portals) and focuses on enabling value-based care, quality improvement, and operational support for providers and payers.

📋 Description

• Manage and oversee regulatory cases from initiation through resolution, ensuring timely and compliant outcomes • Review, analyze, and process regulatory submissions, appeals, and grievances in accordance with state and federal guidelines • Coordinate with internal departments, providers, and external agencies to gather documentation and facilitate case resolution • Monitor regulatory deadlines and maintain accurate case tracking logs and reporting systems • Prepare written correspondence, case summaries, and regulatory reports for internal and external stakeholders • Ensure adherence to DMHC, CMS, and other applicable healthcare regulatory requirements • Identify trends in regulatory cases and recommend process improvements to enhance compliance operations

🎯 Requirements

• 2+ years of experience in regulatory affairs, healthcare compliance, or case management • Strong knowledge of healthcare regulations, including DMHC, CMS, or managed care guidelines • Excellent written and verbal communication skills with the ability to draft clear, professional correspondence • Proficiency in case management systems and Microsoft Office Suite • Strong organizational skills with the ability to manage multiple deadlines simultaneously • Bachelor's degree in Healthcare Administration, Business, or a related field preferred • Detail-oriented, analytical mindset with a commitment to accuracy and compliance.

🏖️ Benefits

• 401(k) • 401(k) matching • Bonus based on performance • Company parties • Dental insurance • Employee discounts • Free food & snacks • Health insurance • Opportunity for advancement • Paid time off • Parental leave • Savings bank • Training & development • Vision insurance • Wellness resources