Scott Tsai

Background

About Scott Tsai

Primary works as a nurse in managed healthcare with specialty in NCQA, and State Medicaid requirements. Most recently as a Delegation Oversight Nurse Auditor enforcing and overseeing delegated activities to ensure State regulation compliance between the health plan and the delegated groups by conducting annual audits of the various delegated health networks. Majority of foundational experience in the Managed Healthcare industry is primarily in Utilization Management as a Nurse clinical reviewer, and in Claims as a Claims review nurse. Having both clinical and health managerial experiences, and extensive knowledge of healthcare network systems, California Lines of business, patient care management using established health plan criteria and CMS, Medi-Cal criteria, and multiple third-party guidelines.Other In-office experience, in back office for Orthopedics, Sports Medicine, Rehab, and Ophthalmology, diagnostic prep work and management systems: QkNotes, TherapyNotes. eClinicalWorks, and etc. Microsoft Office Suites and SQL reporting. I also like cats.