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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 Lead Customer Solution Center Appeals and Grievances RN is responsible for assisting with the development of a successful and cohesive Appeals and Grievance (A&amp;G) clinical unit.This position is responsible for the quality review of complex and/or escalated clinical A&amp;G cases for all line of business (LOB). The Lead will assist in identifying areas of improvement in increasing positive audit outcomes and improved Customer Service to L.A. Care’s (LAC) membership. This position will ensure the effective investigation and resolution of clinical grievances, appeals, complaints, and complex issues in alignment with L.A. Care policy and procedures along with all relevant regulatory guidelines. Leads and works closely with assigned team daily. This position will mentor, coach, and may provide feedback to management on performance of staff. Ensure team effectiveness and project completion.<h4>Duties</h4>Review and process complex and/or escalated clinical A&amp;G cases. Analyze the patient medical records, clinical documentation, and insurance policies to determine medical necessity. Prepares and reviews A&amp;G files for submission to providers and internal departments.Work with other departments to ensure all aspects of a case are appropriately managed.Conduct targeted and random clinical case audits to ensure that all regulatory and departmental guidelines, policies, procedures, and standards are met. Work closely with the leadership team to create and/or modify Desk Level Procedures and recommends enhancements to process and procedures. Assist the Clinical Supervisors in identifying deviations in performance and process changes are implemented to redirect performance to acceptable levels. Recommend and implement resolutions, new processes, and/or process improvement. Provides accurate and timely written statistical reports that includes historical and/or current data to aid in projecting or evaluating compliance status. Identify and analyze trends in appeals and grievances to find the root cause of denials.<h4>Duties Continued</h4>Check, verifies and ensure that all clinical A&amp;G cases are processed accurately and within established timelines to meet or exceed member satisfaction goals and regulatory (CMS, DMHC, DHCS, NCQA), Health and Safety Code and company compliance.Maintains documentation of all communications in the A&amp;G system to ensure thorough tracking of case status.Leads the work of assigned staff; regularly assigns and checks the work of others, providing guidance, training, and feedback on performance to department management. Work closely with management to review performance and quality standards on an ongoing basis. As well as motivational programs needed to achieve regulatory standards.Acts as a back-up to the Supervisor in leading meetings and handling escalations as required.Perform other duties as assigned.<h4>Education Required</h4>Associate's Degree in Nursing for Registered Nurses<h4>Education Preferred</h4>Bachelor's Degree in Nursing for Registered Nurses<h4>Experience</h4>Required:At least 8 years of clinical appeals and grievances experience in a managed care, utilization management and/or case management setting,At least 2 years in Medicare/ Medicaid in a managed care/ health plan environment.At least 1 year of leading a process, program, or staff experience.Preferred:Clinical acute experience.<h4>Skills</h4>Required:Extensive knowledge of healthcare regulations and managed care guidelinesDemonstrated ability to provide recommendations towards resolution.Strong critical thinking and problem-solving abilities to assess complex clinical cases and evaluate medical necessity.Ability to communication, conflict resolution, and motivational skills. Ability to work independently and closely with a team in a collaborative and interactive environment.Ability to adjust to changing circumstances within the team. Good verbal and written communication skills.Preferred:Strong project management skills with the ability to manage multiple training initiatives simultaneously.<h4>Licenses/Certifications Required</h4>Licensed Registered Nurse (RN) - Active, current and unrestricted California License and/or Physician Assistant (PA) - California License Required<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, and 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 assigned.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, Registered Nurse, Medicare, Medicaid, Healthcare

L.A. Care Health Plan

Lead Customer Solution Center Appeals and Grievances RN

<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 MWF

Dialysis Registered Nurse Part Time | MWF

USRC's greatest strength in being a leader in the dialysis industry is our ability to recognize and celebrate the differences in our diverse workforce. We strongly believe in recruiting top talent and creating a diverse and inclusive work climate and culture at all levels of our organization.The Home Therapy Registered Nurse, as qualified by federal and state regulations, provides patient training and ongoing support for all patients choosing a home dialysis modality.&nbsp; This position is accountable for providing quality care to all patients and is committed to delivering superior customer service in all internal and external interactions.&nbsp;&nbsp; ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.&nbsp; Other duties and tasks may be assigned.<ul><li>Knowledge of and comply with federal, state, local laws and regulations, including health care professionals practice act requirements as they pertain to home dialysis program and patient care requirements.</li><li>Train patient (and/or care partner) in the practice of self-care Peritoneal Dialysis or Hemodialysis upon meeting federal and state regulations governing Registered Nurse qualifications.</li><li>Conduct home visits to assess the patient's home environment per policy; initially and minimally annually thereafter.&nbsp; Routinely evaluate patient performance and assess the home environment more frequently as needed to improve care.</li><li>Communicate results of patient assessment, reassessment, and ongoing monitoring to the physician, team members, and others as appropriate to the individual needs of the patient.</li><li>Document all nursing services in the Electronic Medical Record including but not limited to training sessions, routine and non-routine in-person interactions, and phone conversations.&nbsp; Documentation should accurately reflect the patient status and nursing interventions and be written to ensure continuity of care.</li><li>Participate in infection control monitoring, implementation, and recording as requested.</li><li>Be familiar with emergency equipment and all emergency operational procedures.&nbsp; Communicate and regularly review Emergency Preparedness procedures with all home patients, including but not limited to emergency disconnection from dialysis equipment, what to do and who to contact if displaced from home.</li><li>Ensure clinic and patient supply inventory and usage is appropriate for patient prescriptions and place orders in timely manner to avoid fees and penalties.</li><li>Continually seek to improve patient and quality outcomes through tracking and trending of program and patient performance, use of critical thinking skills and root cause analysis to improve patient and quality outcomes.&nbsp; Assist in obtaining data for the continuous quality improvement activities.</li><li>Obtain routine and non-routine laboratory tests as ordered and communicate critical lab values and urgent patient needs to the responsible physician or physician extender in a timely manner.</li><li>Complete and document monthly review of patient medication profiles.&nbsp; Administer medications as ordered by the physician.</li><li>Responsible for performing on call nursing services, nights and weekends, on a rotational basis as needed or assigned.</li><li>Flexible with staffing locations and hours to accommodate patient and USRC home program needs.</li><li>Regular and reliable attendance is required for the position.</li></ul>Home Hemodialysis Only:<ul><li>Coordinate home evaluation with technical services department to ensure that the necessary electrical, plumbing and drainage requirements for proper equipment operation are met prior to patient acceptance into home program.</li><li>Ensure required and appropriate water sampling is complete per policy and product requirements.&nbsp; Monitor and report water sample and culture results.&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</li></ul>

Dialysis Registered Nurse, Home Hemo & Peritoneal RN

SUMMARYThe Acute Registered Nurse provides acute dialysis care and treatment to patients within a hospital environment. This position performs duties as assigned by the Charge Nurse or Acute Manager, including assisting and supervising Patient Care Technicians and Licensed Vocational Nurses. Acute nurses may report directly to an Acute Manager, Administrator or the first line of regional operational management which may be an Area Director, Regional Director, or Vice President of Operations, depending on the region/demographics.Essential Duties and Responsibilities include the following. Other duties and tasks may be assigned.GROWTH· Assist with clinical and operational processes to improve patient health and minimize hospitalizations and rehospitalization.· Ensure patient and treatment charge information and other related data are accurate and submitted appropriately. · Demonstrate effective use of supplies and staff labor hours.· May participate in inventory management, including end-of-month inventory reporting and adherence to company purchasing protocols.· Perform duties as assigned to meet the patient care or operational needs.OUTCOMES· Administer medications as ordered by the physician..· Provide patient education and follow up as needed.· Assist with program's target goals in meeting quality metrics for patient outcomes in accordance with quality patient care and Company goals.OPERATIONALREADINESS· Knowledge of and comply with federal, state, local laws and regulations, including health care professionals practice act requirements.· Perform duties at all times within limitations established by and in accordance with company policy and procedures, hospital policy, applicable state and federal laws and regulations.· Complete water quality verification and equipment safety checks prior to each treatment, to include second verification as required.· Complete pre and post treatment physical assessments.· Complete pre and post Handoff Communication with hospital nurses.· Initiate and terminate patient treatments to include connecting and disconnecting catheters and cleaning catheter sites.· Set up dialysis machines; report machine problems to biomedical technician and/or Acute Manager as appropriate.· Clean, disinfect and provide quality control of dialysis machines as required by policy and procedures.· Participate in infection control monitoring, implementation, and recording as requested.· Use personal protective equipment as necessary.· Be familiar with emergency equipment and all emergency operational procedures, as required by hospital.OPERATIONALREADINESS (cont.)· Demonstrate effective staffing based on acuity, skill mix and company guidelines.· Ensure provision of dialysis related services such as Hemodialysis, Peritoneal dialysis, Continuous Renal Replacement Therapy (CRRT) and Plasmapheresis (TPE) if contracted to do so.· Participate in all surveys as required.· Ensure nursing care is carried out as directed and treatment is administered in accordance with physician orders.· Ensure appropriate and required information is documented in patient records.· Inform Supervisor, Medical Director or Physician and Hospital Liaison of all incidents, conditions, and concerns related to patient care, staff and patient safety, and in accordance with company policy.· Prepare and maintain dialysis machines and systems per policy: maintain dialysis records, prepare dialysis water treatment system for use according to established procedure and understand technical operations to troubleshoot problems independently.· Notify Bio-Medical Technician regarding machine or water treatment malfunctions, values out of parameters and document as required. PARTNERSHIPS· Communicate results of patient assessment, reassessment, and ongoing monitoring to the physician.· Maintain collaborative working relationship with physicians, nurse practitioners, and other hospital healthcare professionals.· Actively promote GUEST customer service standards; develop effective relationships at all levels of the organization.· Address patient concerns timely and professionally; following hospital policy.STAFF DEVELOPMENT/ RETENTION· Participate in staff meetings as required. Attend and complete all company and hospital required in-service and continuing education.· May delegate tasks to competent licensed and unlicensed staff per applicable state practice act.· Assist with staff training as requested.· Lead staff in team concepts and promote a team effort.

Dialysis Registered Nurse - Long Beach Acute

U.S RENAL CARE HIRING EVENT**Date:** Tuesday, November 18, and Wednesday, November 19 ⏰ **Time:** 7 AM - 12 PM and 2 PM - 6 PM Location: Beverly Hills Clinic&nbsp;8420 Wilshire Blvd, Beverly Hills, CA 90211<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.

Dialysis Registered Nurse -U.S. Renal Care In-Person Hiring Event on November 19-20 2025, Beverly Hills, CA

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

Dialysis Licensed Vocational Nurse | Experience is preferred.

Dialysis Registered Nurse TTS

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 Supervisor of Utilization Management (UM) RN is responsible for executing the day-to-day operations of the UM department, and monitoring the Care Management (CM) staff’s responsibilities and activities. This includes, but not limited to, ensuring proper staffing and coverage; monitoring and evaluating departmental operations to ensure optimal efficiency, productivity, and effectiveness; documenting and appropriately addressing excellence or deviations in work, departmental, and organizational expectations; and conducting intermittent and annual performance evaluations. This role assists in triaging identified issues/problems and forming resolution within the scope of work/licensure. The Supervisor is a subject matter expert (SME) in Care/Case/Utilization Management and supporting regulations, policies, protocols, and procedures. This position serves as a formal and informal instructor, and escalates issues/concerns to the appropriate person when outside of their scope.This position is responsible in assisting with and development and maintenance of a successful and cohesive unit, with high level of productivity and accuracy to achieve the department's overall performance metrics. The Supervisor ensures all functions of the UM department are operating in accordance with the organization's mission, values and strategic goals, which are focused on quality care delivery and continuous improvement; and are provided in a manner that is responsive and sensitive to the needs of L.A. Care's culturally diverse membership.The position supports the UM Manager/Director. This role also assists UM Educator/Manager/Director in identification of training needs including, but not limited to, collaborating in development of programs, training materials, competency checklist, and orientation checklists necessary to meet education and training needs of UM staff.&nbsp; The position supervises all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.<h4>Duties</h4>Ensures adequate/appropriate distributions of workforce, assignments and time off requests. &nbsp;Participates in the hiring and termination process providing recommendations with appropriate supporting documentation.Monitors of staff's performance including productivity and compliance with regulatory requirements, compliance with policies. &nbsp;Identifies, communicates and coaches to improve staff performance. &nbsp;Develops tools, job aids, and workflows to optimize the process flow, performance and productivity of the UM team. &nbsp;Completes intermittent and annual staff evaluations.Serves as the primary resource for all business-related questions/issues raised by staff; escalates to appropriate leader/team when necessary.Recommends and implements process improvement measures to achieve department's performance measures outcomes and goals.Plans and oversees UM activities according to model of care, program description and policy and procedures to provide timely, quality care and services to members.Maintains all assigned reporting responsibilities, conducts regular audits to ensure compliance with community, industry and organizational standards including regulatory requirements. Serves as a super-user on electronic programs and systems used by the department.Assists in the development of programs, workflows, tools, training materials, orientation checklists, and competency checklist necessary to meet educational needs. &nbsp;Trains new staff, remediation of seasoned staff and cross training as needed in specified business lines. &nbsp; Serves as a leader and role model as well as technical and informational resource for staff and peers.<h4>Duties Continued</h4>Fosters a culture that encourages employee contribution to ensure that the department maintains an environment in which quality flourishes.Services as member/resource/liaison to the Interdisciplinary Care Team. &nbsp;Recommends resources to improve performance standards in terms of Utilization Management. &nbsp;Collaborates with peers and colleagues within the organization to address process improvements, member's needs, department and organizational enhancements and communicate development as appropriate.Participates on internal and external committees as delegated or assigned.Serves as a consultant to other departments or organizations as needed.Responsible for the daily workflow and leading the work of assigned staff.&nbsp; This role will mentor, coach, act as a resource and provide feedback on performance of assigned staff.Performs other duties as assigned.<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 acute/clinical care experience. Minimum of 2 years of experience in Case/Care/Utilization Management in an acute care or health plan setting. Minimum of 3 years leading process, program, or staff or supervisory experience.Equivalency:&nbsp; Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.<h4>Skills</h4>Required: Knowledge of state, federal and regulatory requirements in Care/Case/Utilization Management.Strong verbal and written communication skills.Computer literacy with proficiency with Microsoft Word, Excel, etc. and ability to learn core departmental computer systems and software.Excellent organizational, time management, and interpersonal skills.Must be detailed-oriented, energetic, and an enthusiastic team player.Must be able to work independently.<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>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, Healthcare

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