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Salary Range:&nbsp;&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. <h4>Job Summary</h4>The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for receiving/reviewing admission requests and higher level of care (HLOC) transfer requests from inpatient facilities within regular timelines. Reviews clinical data in real-time and post admission to issue a determination based on clinical criteria for medical necessity. Assures timely, accurate determination and notification of admission and inter-facility transfer requests. Generates approval, modification, and denial communications for inpatient admission requests. Actively monitors for appropriate level of care (inpatient vs. observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director, on requests where determination requires extended review. Collaborates with the inpatient care team for facilitation/coordination of patient transfers between acute care facilities. Acts as a department resource for medical service requests/referral management and processes. Actively participates in the discharge planning process, including providing clinical review and authorization for alternate levels of care, home health, durable medical equipment, and other discharge needs. Provides support to the inpatient review team as necessary to ensure timely processing of concurrent reviews.<h4>Duties</h4> Provides the primary clinical point of contact for inpatient acute care hospitals requesting Inpatient care/post-stabilization admission requests, Higher level of care transfers and other emergent transfers or needs. Ensures appropriate determination for admission requests/HLOC transfers based on clinical data presented and established criteria/guidelines, escalating to the medical director if needed. &nbsp;Triages and assesses members for admission needs, including, but not limited to, bed and accepting physician availability. (40%)Establishes and maintains ongoing communication with internal stakeholders and external customers while securing the L.A. Care member's admission or inter-facility transfer. &nbsp;Interfaces with physicians, house supervisors, and other hospital delegates to ensure that telephone triage results in appropriate patient placement. (10%)Applies clinical expertise and the nursing process to triage and prioritize admission acuity, servicing as an expert clinical resource for patient placement while utilizing medical knowledge and experience to facilitate consensus-building and development of satisfactory outcomes (10%)Continually seeks new ways to improve processes and increase efficiencies. Takes the initiative to communicate recommendations to UM Leadership. (5%)Completes all inpatient and discharge planning requests appropriately and timely including, but not limited to: &nbsp;Skilled nursing facility, outpatient needs (home health, physical therapy, infusion), and case management referrals (5%) Performs prospective, concurrent, post-service, and retrospective claim medical review processes. Utilizes clinical judgement, independent analysis, critical-thinking skills, detailed knowledge of medical policies, clinical guidelines and benefit plans to complete reviews and determinations within required turnaround times specific to the case type. Identifies requests needing medical director review or input and presents for second level review (20%)Performs other duties as assigned. (10%)<h4>Duties Continued</h4><h4>Education Required</h4>Associate's Degree in Nursing<h4>Education Preferred</h4>Bachelor's Degree in Nursing<h4>Experience</h4>Required: Minimum of 7 years of clinical experience in an acute hospital setting.&nbsp;Previous experience to have a strong understanding of Utilization Management/Case Management practices including, but not limited to, placement (with level of care) criteria (MCG, InterQual), concurrent review, and discharge planning.Preferred: Consistent Critical Care experience (Emergency Department, Intensive Care, Labor &amp; Delivery) background highly desirable.Experience in bed placement decision-making highly desirable.<h4>Skills</h4>Required: Must be computer literate, with expertise in Outlook, Word, Excel, PowerPoint. &nbsp;Provision of excellent customer service required due to frequent communication with providers and other members of the interdisciplinary team &nbsp;Knowledge of personal computer, keyboarding, and appropriate software to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Prepare clear, comprehensive written and oral reports and materials.&nbsp;Excellent time management and priority-setting skills.Maintains strict member confidentiality and complies with all HIPAA requirements.Strong verbal and written communication skills. &nbsp; &nbsp;Preferred: Knowledge of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or CM.&nbsp;Knowledge of Department of Health Care Services (DHCS) or Centers for Medicare and Medicaid Services(CMS) requirements for health plan compliance with UM or CM.<h4>Licenses/Certifications Required</h4>Registered Nurse (RN) - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4>Certified Case Manager (CCM)American Case Management Association (ACM)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4>Required: Attend mandatory department trainings as scheduledFinancial Impact: Management of all medical services has a tremendous potential impact on the cost of health care and budget. This position manages determinations to ensure services requested are medically appropriate and provided in the most cost effective manner without compromising quality healthcare delivery.Types of Shift: &nbsp;Day (7:00am - 3:30pm), Evening (3:00pm -11:30 pm), Night (11:00pm -7:30am).&nbsp; Float (Varies)* *All possible shifts.Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.L.A. Care offers&nbsp;a wide range of benefits including<ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul> Nearest Major Market: Los Angeles Job Segment: Nursing, Registered Nurse, Emergency Medicine, Physical Therapy, Rehabilitation, Healthcare

L.A. Care Health Plan

Utilization Management Admissions Liaison RN II

Salary Range:&nbsp;&nbsp;$117,509.00&nbsp;(Min.) -&nbsp;$152,762.00&nbsp;(Mid.) -&nbsp;$188,015.00&nbsp;(Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. <h4>Job Summary</h4>The Manager, Appeals &amp; Grievances (A&amp;G) &amp; General Operations (Clinical) is responsible for the daily oversight of clinical appeals and grievances functions within the Appeals &amp; Grievances Department to ensure clinical grievances, complaints, appeals and complex issues are investigated and resolved using regulatory guidance across all lines of business. Provides direct supervision to the A&amp;G clinical team and the unit that supports them in order to assure operational effectiveness which includes the implementation and adherence to L.A. Care's Policies &amp; Procedures that meet Centers for Medicare and Medicaid Services (CMS), the California Department of Health Care Services (DHCS), the California Department of Managed Health Care (DMHC), the Managed Risk Medical Insurance Board (MRMIB), National Committee for Quality Assurance (NCQA) and other rules/ regulations/ standards. The Manager is responsible for establishing and monitoring processes to oversee and coordinate the identification, documentation, reporting, investigation and resolution of all member appeals and grievances in a timely and culturally-appropriate manner. Coordinates, tracks, and resolves internal and external appeal and grievance complaints for L.A. Care Plan Partners, including identifying opportunities for improvement.This position will be a role model for integrity and will establish and maintain effective professional work relationships, working collaboratively with all levels of management and business owners to help guide the discipline of planning, organizing, securing, managing, leading, and controlling resources to achieve specific goals.Manages all aspects of running an efficient &nbsp;team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.&nbsp;<h4>Duties</h4>Manage and oversee the handling of clinical grievances and appeals, for L.A. Care and Plan Partner members. Establishes and oversees processes and all relevant member correspondence for accuracy, clarity, and cultural appropriateness and sensitivity. Review and monitor procedures for identifying quality of care issues and work collaboratively with cross-functional departments to appropriately address and resolve member grievances. Serve as the Key Contact for State Fair Hearings, internal and external audits, DMHC and DHCS inquiries. Review and monitor procedures for identifying quality of care issues and work collaboratively with cross-functional departments to appropriately address and resolve member and provider grievances.Responsible for timely daily operations in the A&amp;G Clinical Services Unit and other general operations units. &nbsp;Ensures timely appeal and grievance reporting to regulatory agencies, internal Regulatory Affairs and Compliance Department, internal Quality Oversight Committee, etc. Collaborates with cross-functional departments &nbsp;to ensure the use of appropriate appeal and grievance issue codes, timely resolution, and refers to community partners as appropriate. &nbsp;Lead, participate and provide representation of the A&amp;G Team at Internal and External meetings/ workgroups and acts as the point person for A&amp;G Programs especially the Clinical Programs.Develop and execute on strategic opportunities to improve the overall appeals &amp; grievance process. Create a best in clinical appeals process that is efficient and effective in managing member appeals.Work cross functionally and collaboratively within Appeals and Grievances with key internal partners to build a high functioning, results oriented environment and organization.&nbsp;<h4>Duties Continued</h4>Partner with internal and external stakeholders to build and maintain collaborative relationships and partnerships. Identify areas of connection to leverage and create added value for L.A. Care.Provide input into the development of automation to guide the team to process efficiencies for all lines of business while maintaining compliance and manageable workloads for staff.Responsible for maintaining and updating on an annual basis, or as necessary, appeal and grievance policies and procedures, member correspondence, etc., consistent with regulatory changes. &nbsp;Develop and maintain inventory reports for the appeals process ensuring appropriate productivity, compliance, and inventory management. &nbsp;Identify and implement continuous business process improvement recommendations to leverage organizational added value to the Appeals and Grievances Department. &nbsp;Develop and implement short and long-term strategies to improve team results, reducing administrative expenses.Manage staff , including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others. Supervision of the Clinical Services unit and general operations within Appeals and Grievances. Maintain a team of top talent, providing a culture of teamwork and collaboration.&nbsp;Perform other duties as assigned<h4>Education Required</h4>Bachelor's Degree in Nursing<h4>Education Preferred</h4><h4>Experience</h4>Required:6 years of clinical acute care experience with at least 3 years of experience with health care grievance and/or appeals issues, preferably in a managed care or Medicaid Health Plan environment and/or public services or public benefits programs.At least 3 years of management level operations leadership experience.Experience working with firm deadlines, regulators, detail oriented with the ability to interpret and apply regulationsExperience building relationships with organizations and business partners.Equivalency:&nbsp; Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.Preferred:&nbsp; Managed care experience.<h4>Skills</h4>Required: Excellent analytical, problem solving, planning and implementation skills.Demonstrated strong writing and communication skills.Demonstrates excellent leadership, communication, and negotiation skills with the ability to interact and influence all levels of the organization including executive management and key decision -makers.Demonstrates professional judgement, and critical thinking, to promote the delivery of quality, cost-effective care.Time management and priority setting skills.Excellent understanding of NCQA, DMHC, DOI, DHCS, and CMS regulatory requirements.Knowledge of Coordination of Care, Medicare and Medi-Cal regulations, prior authorization, level of care and length of stay criteria sets.Able to work effectively with various internal departments/service areas, L.A. Care's plan partners, participating provider groups, and other external agencies.Able to operate PC-based software programs including proficiency in Word, Excel and PowerPoint presentations.Excellent verbal, written communication and presentation skills.<h4>Licenses/Certifications Required</h4>Registered Nurse (RN) - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4>This position requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical situations and work on-call.This position requires handling various caseloads and flexibility to adapt to changing priorities which may include but not limited to redistributed work assignments, team projects, and other priorities as assignedSalary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.L.A. Care offers&nbsp;a wide range of benefits including<ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul> Nearest Major Market: Los Angeles Job Segment: Nursing, Registered Nurse, Nurse Management, Medicaid, Medicare, Healthcare

Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical)

<h4>How you'll change lives</h4>As a Registered Nurse (RN) at US Renal Care, you'll be an integral part of a cross-functional team, working under the supervision of a Charge Nurse and assisting and supervising Patient Care Technicians (PCTs) to care for patients living with kidney disease.<h4>What you'll be doing</h4>Patient care. You'll work directly with patients to provide safe, comfortable, and high-quality dialysis treatment. Responsibilities include completing and documenting physical assessments before and after treatments and monitoring patients during treatment. You'll ensure quality renal care by completing monthly reviews of patient medication profiles and administering medications according to physician orders. Teamwork. You'll be a critical member of an interdisciplinary team to provide all required patient assessment and care planning activities. You'll also make sure center staffing requirements are met at all times under the direction of the Administrator and according to state regulations for staffing ratios.Safety &amp; Quality. Working under the supervision of a Charge Nurse, you'll adhere to all company policies and procedures and state and federal laws and regulations. You'll participate in all required staff meetings and continuing education offerings.

U.S. Renal Care

Dialysis Registered Nurse

Essential Duties and Responsibilities include the following. Other duties and tasks may be assigned.<ul><li>Demonstrate effective use of supplies and staff labor hours.</li><li> May assist with billing log preparation and updates.</li><li>Perform duties as assigned to meet the patient care or operational needs of the clinic</li><li> Obtain blood samples for laboratory analysis as required to complete physician orders.</li><li> Complete and document monthly review of patient medication profiles.</li><li>Knowledge of and comply with applicable health care professionals practice act requirements.</li><li>Perform duties at all times under the supervision of a Charge Nurse and within limitations established by and in accordance with company policy and procedures, applicable state and federal laws and regulations</li><li>Maintain thorough, accurate, and appropriate documentation in the patient record of all treatments, activities, and communication with the patient, physician and other healthcare professionals to include progress reports.</li><li>Report any significant information or change in patient condition to the Charge Nurse.</li><li> Report machine problems to Biomedical Technician and Administrator.</li><li> Participate in staff meetings as required. Attend in-service and continuing education offerings in compliance with company policy and procedure.</li><li>Assist with staff training as requested.</li></ul>

Dialysis Licensed Vocational Nurse

Come care with us at West Coast University! As a Nursing Faculty member for a certified Great Place to Work, you will guide nursing students to do more than change their own lives – you will help change the lives of every patient they treat throughout their career in healthcare. &nbsp;At West Coast University you will have the opportunity to share your success story with the next generation of nurses as a key member of our student-centered, innovative community!You will make an impact by: &nbsp;<ul><li>Serving as a mentor, role model and facilitator who provides guidance and academic support for students. </li><li>Demonstrating enthusiasm for teaching, the teaching/learning process and for individual students.</li><li>Applying your skills and experience to your assigned teaching schedule.</li><li>Participating in and contributing to assessment activities of courses/curriculum and programs via a continuous improvement plan set forth by the University.</li><li>Regularly contributing to improvement of class materials and syllabi within prescribed shared governance culture.</li><li>Utilizing a variety of teaching methodologies to instruct students, always with intent to facilitate observable evidence of student fulfillment of prescribed learning outcomes.</li><li>Maintaining scholarly activities.</li><li>Participating in professional growth and service in accordance with university policies.</li><li>Advancing our commitment and focus on the students we serve, and their success as healthcare professionals.</li><li>Fully leveraging our innovative technologies and resources, such as our Simulation and Innovation Labs.</li><li>*If working with students in a Clinical setting you will:<ul><li>Assume complete responsibility for students in clinical facilities. </li><li>Clarify clinical expectations with students.</li><li>Clarify student placement and expectations with clinical facility staff.</li><li>Utilize care planning time to direct students to available resources needed for clinical preparation. </li><li>Assess student knowledge and skill level to ensure safety and optimal care to patients.</li><li>Utilize pre- and post- conference to allow students an opportunity to share learned experiences, ensuring clarity of the correlation between &nbsp;weekly theory content with clinical objectives and experiences.</li><li>Provide feedback of clinical performance immediately after observation of event and of overall performance at midterm and end of semester.</li></ul></li></ul>Your Experience Includes: &nbsp;<ul><li>Working knowledge of Microsoft Office Suite Products, especially Outlook, Word, PowerPoint and other MS office products as needed.</li><li>Working with online learning management systems to further engage the student learning process.</li><li>Compliance with state, federal and local laws/regulations relating to programs, governmental compliance, and other regulatory standards such as state Board of Nursing.</li><li>Clinical RN - Must have a minimum of two (2) year’s prior experience as a registered nurse providing direct patient care and have a minimum of one year experience in the field in which they teach.</li></ul>Education: Education and experience must align with state regulations and comply with the rules and regulations of state authorization agencies.<ul><li>Master’s degree in nursing</li><li>Professional nurse licensure required.</li></ul>#LI-AM1Do you want a career that allows you to make a difference in other people’s lives? Discover what it means to truly believe in the work that you do at West Coast University.At West Coast University, we have the privilege of educating students seeking careers in healthcare and guide them through their transformational journey from student to caregiver. Our associates are united behind that purpose and share a deep commitment to our values of teamwork, collegiality, transparency, and a student-centric approach to all we do. This focus creates an aligned, nimble, and consensus-driven culture that is solution-oriented and supports our associates’ professional growth.West Coast University is proud to be an equal opportunity employer. We embrace diversity and are dedicated to creating an inclusive environment for all associates.

West Coast University

Adjunct Clinical Instructor, Nursing (OB - Day)

Come care with us at West Coast University! As a Nursing Faculty member for a certified Great Place to Work, you will guide nursing students to do more than change their own lives – you will help change the lives of every patient they treat throughout their career in healthcare. &nbsp;At West Coast University you will have the opportunity to share your success story with the next generation of nurses as a key member of our student-centered, innovative community!You will make an impact by: &nbsp;<ul><li>Serving as a mentor, role model and facilitator who provides guidance and academic support for students.</li><li>Demonstrating enthusiasm for teaching, the teaching/learning process and for individual students.</li><li>Applying your skills and experience to your assigned teaching schedule.</li><li>Participating in and contributing to assessment activities of courses/curriculum and programs via a continuous improvement plan set forth by the University.</li><li>Regularly contributing to improvement of class materials and syllabi within prescribed shared governance culture.</li><li>Utilizing a variety of teaching methodologies to instruct students, always with intent to facilitate observable evidence of student fulfillment of prescribed learning outcomes.</li><li>Maintaining scholarly activities.</li><li>Participating in professional growth and service in accordance with university policies.</li><li>Advancing our commitment and focus on the students we serve, and their success as healthcare professionals.</li><li>Fully leveraging our innovative technologies and resources, such as our Simulation and Innovation Labs.</li><li>*If working with students in a Clinical setting you will:<ul><li>Assume complete responsibility for students in clinical facilities.</li><li>Clarify clinical expectations with students.</li><li>Clarify student placement and expectations with clinical facility staff.</li><li>Utilize care planning time to direct students to available resources needed for clinical preparation.</li><li>Assess student knowledge and skill level to ensure safety and optimal care to patients.</li><li>Utilize pre- and post- conference to allow students an opportunity to share learned experiences, ensuring clarity of the correlation between &nbsp;weekly theory content with clinical objectives and experiences.</li><li>Provide feedback of clinical performance immediately after observation of event and of overall performance at midterm and end of semester.</li></ul></li></ul>Your Experience Includes: &nbsp;<ul><li>Working with online learning management systems to further engage the student learning process.</li><li>Compliance with state, federal and local laws/regulations relating to programs, governmental compliance, and other regulatory standards such as state Board of Nursing.</li><li>Clinical RN - Must have a minimum of two (2) year’s prior experience as a registered nurse providing direct patient care and have a minimum of one year experience in the field in which they teach.</li></ul>Education:<ul><li>Education and experience must align with state regulations and comply with the rules and regulations of state authorization agencies.</li><li>Master’s degree in nursing</li><li>Professional nurse licensure required.</li></ul>Schedule:<ul><li>Required commitment is three 10-hour day shifts per week for each 10-week session at one of our clinical partner sites.&nbsp;</li><li>Clinicals are scheduled at healthcare facilities within a 50-mile radius of the Ontario campus, in any direction.</li></ul>#LI-CM1Do you want a career that allows you to make a difference in other people’s lives? Discover what it means to truly believe in the work that you do at West Coast University.At West Coast University, we have the privilege of educating students seeking careers in healthcare and guide them through their transformational journey from student to caregiver. Our associates are united behind that purpose and share a deep commitment to our values of teamwork, collegiality, transparency, and a student-centric approach to all we do. This focus creates an aligned, nimble, and consensus-driven culture that is solution-oriented and supports our associates’ professional growth.West Coast University is proud to be an equal opportunity employer. We embrace diversity and are dedicated to creating an inclusive environment for all associates.

Nursing Clinical Faculty - Critical Care

Come care with us at West Coast University! As a Nursing Faculty member for a certified Great Place to Work, you will guide nursing students to do more than change their own lives – you will help change the lives of every patient they treat throughout their career in healthcare. &nbsp;At West Coast University you will have the opportunity to share your success story with the next generation of nurses as a key member of our student-centered, innovative community!Full-Time OBYou will make an impact by: &nbsp;<ul><li>Serving as a mentor, role model and facilitator who provides guidance and academic support for students.</li><li>Demonstrating enthusiasm for teaching, the teaching/learning process and for individual students.</li><li>Applying your skills and experience to your assigned teaching schedule.</li><li>Participating in and contributing to assessment activities of courses/curriculum and programs via a continuous improvement plan set forth by the University.</li><li>Regularly contributing to improvement of class materials and syllabi within prescribed shared governance culture.</li><li>Utilizing a variety of teaching methodologies to instruct students, always with intent to facilitate observable evidence of student fulfillment of prescribed learning outcomes.</li><li>Maintaining scholarly activities.</li><li>Participating in professional growth and service in accordance with university policies.</li><li>Advancing our commitment and focus on the students we serve, and their success as healthcare professionals.</li><li>Fully leveraging our innovative technologies and resources, such as our Simulation and Innovation Labs.</li><li>*If working with students in a Clinical setting you will:<ul><li>Assume complete responsibility for students in clinical facilities.</li><li>Clarify clinical expectations with students.</li><li>Clarify student placement and expectations with clinical facility staff.</li><li>Utilize care planning time to direct students to available resources needed for clinical preparation.</li><li>Assess student knowledge and skill level to ensure safety and optimal care to patients.</li><li>Utilize pre- and post- conference to allow students an opportunity to share learned experiences, ensuring clarity of the correlation between &nbsp;weekly theory content with clinical objectives and experiences.</li><li>Provide feedback of clinical performance immediately after observation of event and of overall performance at midterm and end of semester.</li></ul></li></ul>Your Experience Includes: &nbsp;<ul><li>Working knowledge of Microsoft Office Suite Products, especially Outlook, Word, PowerPoint and other MS office products as needed.</li><li>Working with online learning management systems to further engage the student learning process.</li><li>Compliance with state, federal and local laws/regulations relating to programs, governmental compliance, and other regulatory standards such as state Board of Nursing.</li><li>Clinical RN - Must have a minimum of two (2) year’s prior experience as a registered nurse providing direct patient care and have a minimum of one year experience in the field in which they teach.</li><li>Required commitment is three 12-hour shifts per week for each 10-week session at one of our clinical partner sites. Clinical schedules vary by session and may include weekdays, weekends, or night shifts, depending on the specialty.</li><li>Clinicals are scheduled at healthcare facilities within a 50-mile radius of the Ontario campus, in any direction.</li></ul>Education: Education and experience must align with state regulations and comply with the rules and regulations of state authorization agencies.<ul><li>Master’s degree in nursing</li><li>Professional nurse licensure required.</li></ul>#LI-CM1Do you want a career that allows you to make a difference in other people’s lives? Discover what it means to truly believe in the work that you do at West Coast University.At West Coast University, we have the privilege of educating students seeking careers in healthcare and guide them through their transformational journey from student to caregiver. Our associates are united behind that purpose and share a deep commitment to our values of teamwork, collegiality, transparency, and a student-centric approach to all we do. This focus creates an aligned, nimble, and consensus-driven culture that is solution-oriented and supports our associates’ professional growth.West Coast University is proud to be an equal opportunity employer. We embrace diversity and are dedicated to creating an inclusive environment for all associates.

Nursing Clinical Faculty - Obstetrics

Salary Range:&nbsp;&nbsp;$102,183.00&nbsp;(Min.) -&nbsp;$132,838.00&nbsp;(Mid.) -&nbsp;$163,492.00&nbsp;(Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. <h4>Job Summary</h4>The Payment Integrity Nurse Coder RN III is responsible for investigating, reviewing, and providing clinical and/or coding expertise/judgement in the application of medical and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The position serves as a subject matter expert (SME), performing medical records reviews to include quality audits as well as validation of accuracy and completeness of all coding elements. The position is also responsible for guidance related to Payment Integrity initiatives to include concept and cost avoidance development. This position trains and mentors Payment Integrity Nurse Coder, RN staff. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.<h4>Duties</h4>Performs Quality Audits to include validation of accuracy and completeness of ICD, Rev Code, CPT, HCPCs, APR, DRG, POA, and all relevant coding elements. Audits can include inpatient, outpatient, and professional claims.Serves cross functionally with Utilization Management, Medical Directors, and other internal teams to assist in identification of overpayments as well as other projects.Serves as SME for all Payment Integrity functions to include both Retrospective Data Mining as well as Pre-Payment Cost Avoidance. Identifies trends and patterns with overall program and individual provider coding practices.Responsible for training and mentoring Payment Integrity Nurse Coder, RN staff.Supports the creation and execution of strategies that determine impact of opportunity and recover overpayments as well as prospective internal controls preventing future overpayments of each applicable pipeline opportunity. Works with both internal and external groups to define and develop cost avoidance measures to ensure continued success.Identifies and defines Payment Integrity issues and reviews and analyzes evidence, utilizes data for the purpose of verifying errors and identifying systemic errors, works as an active team member during scheduled engagements and work collaboratively to achieve the goals of the team, and provides feedback to the team lead on any issues identified during research or claims review.Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.Performs other duties as assigned.<h4>Duties Continued</h4><h4>Education Required</h4>Associate's Degree in Nursing<h4>Education Preferred</h4>Bachelor's Degree in Nursing<h4>Experience</h4>Required:At least 8 years of clinical RN experience.At least 3 years of experience in utilization management or clinical coding.Investigation and/or auditing experience.<h4>Skills</h4>Required:Knowledge in CPT, HCPCS, ICD-9, ICD-10, Medicare, and Medicaid rules and regulations.Knowledge of healthcare reimbursement concepts, health insurance business, industry terminology, and regulatory guidelines.Working knowledge of claims coding and medical terminology.Solid understanding of standard claims processing systems and claims data analysis.Strong project leadership and management skills required; ability to prioritize, plan, and handle multiple tasks/demands simultaneously.Excellent interpersonal, verbal, and written communication skills required with excellent analytical and problem-solving skills. Detail oriented and ability to thrive in fast-paced work environment.Must be collaborative and have the ability to establish credibility quickly with all levels of management across multiple functional areas and be able to present findings across all departments.Must be familiar with coordinating benefits between health plan payers.Advanced knowledge of Microsoft Office suite, including Word, Excel and PowerPoint.<h4>Licenses/Certifications Required</h4>Registered Nurse (RN) - Active, current and unrestricted California LicenseCertified Professional Coder (CPC) designation by the American Academy of Professional Codersand/orCertified Coding Specialist (CCS) designation by the American Health Information Management Association (AHIMA).<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.L.A. Care offers&nbsp;a wide range of benefits including<ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul> Nearest Major Market: Los Angeles Job Segment: Nursing, Medical Coding, Registered Nurse, Claims, Medicare, Healthcare, Insurance

Payment Integrity Nurse Coder RN III

Nursing Clinical Faculty - Med/Surg

At American Career College, we share a&nbsp;passion for students and transforming healthcare education!&nbsp;As an associate for a certified Great Place to Work, you will join a collaborative, student-centric culture valuing academic integrity, mutual respect, student learning, service, responsiveness, innovation, diversity, and stewardship.&nbsp; As a part of this team, you will guide students to do more than change their own lives – you will help change the lives of every patient they care for throughout their career. At American Career College, you will have the opportunity to share your expertise and passion with the next generation of nurses.You will make an impact by:&nbsp;<ul><li>Providing leadership in managing and implementing a comprehensive post-secondary program for delivery in support of American Career College, Ontario.&nbsp;</li><li>Participating in budget preparation and fiscal administration, curriculum development and coordination, determination of teaching assignments, supervision and evaluation of faculty, and selection/coordination of program specific external clinical facilities, teaching responsibilities in the classroom and facilitating strategies for passing of the certification/licensure examination</li><li>Providing professional leadership and support for teaching faculty; serves as a mentor and facilitator for faculty assigned; and enables an environment which fosters creativity, responsiveness, and self-responsibility.</li></ul>Your Experience Includes:<ul><li>Two (2) years' experience teaching in pre- or post-licensure registered nursing programs.</li><li>Meet one of the two following requirements:<ul><li>One (1) year's continuous, full-time or its equivalent experience in direct patient care as a registered nurse; or</li><li>Equivalent experience and/or education, as determined by the board.</li></ul></li></ul>Education:<ul><li>A minimum of a master's degree from an academic institution accredited by a regional or national accrediting agency that is recognized by the U.S. Department of Education which includes course work in nursing, education or administration required.</li><li>Current unencumbered Registered Nurse License in California required.</li><li>Current CPR Card.</li><li>American Heart Basic Life Support (BLS) Certification.</li><li>Must have approval by the Board of Registered Nursing (BRN) prior to assuming the role of Director of Nursing.</li></ul>

19 Nursing Jobs in Anaheim, CA, USA