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<h4><em><strong>How you'll change lives</strong></em></h4><p>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.</p><h4><em><strong>What you'll be doing</strong></em></h4><p><strong>Patient care.</strong> 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. </p><p><strong>Teamwork.</strong> 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.</p><p><strong>Safety &amp; Quality.</strong> 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.</p>

U.S. Renal Care

Dialysis Registered Nurse

<p><b>Salary Range:&nbsp;</b>&nbsp;$117,509.00&nbsp;(Min.) -&nbsp;$152,762.00&nbsp;(Mid.) -&nbsp;$188,015.00&nbsp;(Max.)</p><p>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.<br><br>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.<br></p><h4>Job Summary</h4><p>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.<br><br>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.</p><p>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.</p><p>Manages all aspects of running an efficient &nbsp;team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.&nbsp;</p><h4>Duties</h4><p>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.<br><br>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.</p><p>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;</p><p>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.</p><p>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.</p><p>Work cross functionally and collaboratively within Appeals and Grievances with key internal partners to build a high functioning, results oriented environment and organization.&nbsp;</p><h4>Duties Continued</h4><p>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.</p><p>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.</p><p>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;</p><p>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.</p><p>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;</p><p>Perform other duties as assigned</p><h4>Education Required</h4>Bachelor's Degree in Nursing<h4>Education Preferred</h4><h4>Experience</h4><p><b>Required:</b></p><p>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.</p><p>At least 3 years of management level operations leadership experience.</p><p>Experience working with firm deadlines, regulators, detail oriented with the ability to interpret and apply regulations</p><p>Experience building relationships with organizations and business partners.</p><p><b>Equivalency:</b>&nbsp; Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.</p><p><b>Preferred:&nbsp; </b></p><p>Managed care experience.</p><h4>Skills</h4><p><b>Required:</b><br>Excellent analytical, problem solving, planning and implementation skills.</p><p>Demonstrated strong writing and communication skills.</p><p>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.</p><p>Demonstrates professional judgement, and critical thinking, to promote the delivery of quality, cost-effective care.</p><p>Time management and priority setting skills.</p><p>Excellent understanding of NCQA, DMHC, DOI, DHCS, and CMS regulatory requirements.</p><p>Knowledge of Coordination of Care, Medicare and Medi-Cal regulations, prior authorization, level of care and length of stay criteria sets.</p><p>Able to work effectively with various internal departments/service areas, L.A. Care's plan partners, participating provider groups, and other external agencies.</p><p>Able to operate PC-based software programs including proficiency in Word, Excel and PowerPoint presentations.</p><p>Excellent verbal, written communication and presentation skills.</p><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><p>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.</p><p>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</p><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><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><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Nursing, Registered Nurse, Nurse Management, Medicaid, Medicare, Healthcare                                                    </p>

L.A. Care Health Plan

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

<p><strong>Essential Duties and Responsibilities</strong> include the following. Other duties and tasks may be assigned.</p><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

<p><b>Job Description:</b></p><p><b>Position Summary</b>:</p><p>Reporting to the Director of Student Advising, Student Support Counselors (SSC) are the single-point of access for students and provides student-centered support services. SSCs administer a high-level of student service to ensure retention, student satisfaction, and success of students. SSCs are responsible for adhering to all internal, federal, Department of Education, and affiliate policies and procedures. Student contact is extensive and substantive as is maintaining accurate records in order to support students through their programs. Staff members are expected to exercise a high degree of responsibility and independent judgment, and to work hours consistent with the campus student populations’ need for access to services. We are looking to fill this position for the Anaheim campus. The position is a hybrid with work both on campus and remote.</p><p><b>About the Department:</b></p><p>The Student Support Services department operates in four distinct areas: Advising, Operations, Student Experience, and Student Wellness. Each area is managed by a director and houses numerous student support divisions that service all students at TCSPP. We aim to create a thorough support network for students and to enhance their classroom education through cocurricular experiences. All staff in the department administer a high-level of customer service to ensure student persistence and success. Student Support Services team members work collaboratively with many other campus-wide constituent groups. Team members are expected to exercise a high degree of responsibility and independent judgment, and to work hours consistent with the campus student populations’ need for access to services, which will include occasional evenings and weekends.&nbsp;<br><br><b>Principle Duties:</b></p><ul><li>Work with and support new and continuing students at various stages of their education.</li><li>Administration of advising services including registration, evaluation of program requirements, incomplete grades, student class activity, Satisfactory Academic Progress, and overall degree progress.</li><li>Call/meet with each student throughout the term to ensure they are successfully completing coursework and to provide support.</li><li>Respond to calls and e-mails from incoming or current students on a daily basis by providing guidance regarding course work, policies, and support.</li><li>Ensure student’s academic account/record are accurate and up-to-date by clear and timely processing of important academic forms (e.g. Add/Drop, Withdrawal, Leave of Absence, etc.).</li><li>Advising at-risk students through work/life balance, time management, other circumstances to ensure successful completion of the course and program.</li><li>Advising students on course/program content and registration in degree program of study.</li><li>Follow-up on the progress of&nbsp;Academic Plans for students on who do not meet the Satisfactory Academic Progress Requirements or are in need of additional support.</li><li>Collaborate with various student facing departments such as Academics, Financial Aid, Admissions, and Student Accounts to ensure the success of the student.</li><li>Work with Office of the Registrar to ensure that incoming and current students receive timely information and guidance regarding institutional policies, course registration, program completion, etc.</li><li>Advise students on support services and resources available to them through their school.</li><li>Adherence to set internal, federal, DOE, and affiliate policies and procedures, integrity and ethical standards.</li><li>Perform other duties as assigned.<br></li></ul><p><b>Essential Knowledge, Skills, and Abilities:</b></p><ul><li>Excellent PC skills (Word, Excel, Power Point) and other clerical skills (phone skills, typing, filing)</li><li>Skills to establish and maintain effective relationships</li><li>Excellent verbal and written communication skills</li><li>Organizational and time management skills</li><li>Ability to collaborate and communicate with all students regardless of educational level as well as all employees regardless of position, title, or location</li><li>Excellent team work</li></ul><p><br><b>Position Qualifications:</b></p><ul><li>Bachelor's degree required</li><li>Experience within student facing positions and/or higher education preferred</li><li>Ability to work weekends and evenings</li></ul><p><b>Compensation &amp; Benefits</b></p>This opportunity is budgeted at $21.79 - $25.36 base compensation. Additional compensation factors may impact total compensation. To learn more about our competitive benefits and additional rewards, including generous paid time-off, medical and dental insurance coverage, life and disability insurance, retirement plan with employer contribution, multiple flexible spending accounts, tuition reimbursement, click the link below.<p><a href="https://www.thechicagoschool.edu/career-opportunities/" target="_blank">https://www.thechicagoschool.edu/career-opportunities/</a></p><p>The Chicago School is an Equal Opportunity Employer.</p><p>Please note: For the protection of faculty, staff, students, and all who enter our facilities, The Chicago School strongly recommends that all employees are fully vaccinated for COVID-19 per CDC guidance.</p>

The Chicago School of Professional Psychology

Student Support Counselor - Los Angeles

<p><b>Salary Range:&nbsp;</b>&nbsp;$102,183.00&nbsp;(Min.) -&nbsp;$132,838.00&nbsp;(Mid.) -&nbsp;$163,492.00&nbsp;(Max.)</p><p>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.<br><br>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.<br></p><h4>Job Summary</h4><p>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.</p><h4>Duties</h4><p>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.</p><p>Serves cross functionally with Utilization Management, Medical Directors, and other internal teams to assist in identification of overpayments as well as other projects.</p><p>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.</p><p>Responsible for training and mentoring Payment Integrity Nurse Coder, RN staff.</p><p>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.</p><p>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.</p><p>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.</p><p>Performs other duties as assigned.</p><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><p><b>Required:</b></p><p>At least 8 years of clinical RN experience.</p><p>At least 3 years of experience in utilization management or clinical coding.</p><p>Investigation and/or auditing experience.</p><h4>Skills</h4><p><b>Required:</b></p><p>Knowledge in CPT, HCPCS, ICD-9, ICD-10, Medicare, and Medicaid rules and regulations.</p><p>Knowledge of healthcare reimbursement concepts, health insurance business, industry terminology, and regulatory guidelines.</p><p>Working knowledge of claims coding and medical terminology.</p><p>Solid understanding of standard claims processing systems and claims data analysis.</p><p>Strong project leadership and management skills required; ability to prioritize, plan, and handle multiple tasks/demands simultaneously.</p><p>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.</p><p>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.</p><p>Must be familiar with coordinating benefits between health plan payers.</p><p>Advanced knowledge of Microsoft Office suite, including Word, Excel and PowerPoint.</p><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><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><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><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Nursing, Medical Coding, Registered Nurse, Claims, Medicare, Healthcare, Insurance                                                    </p>

Payment Integrity Nurse Coder RN III

Dialysis Registered Nurse TTS

<br><h4><em><strong>How you'll change lives</strong></em></h4><p>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.</p><h4><em><strong>What you'll be doing</strong></em></h4><p><strong>Patient care.</strong> 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. </p><p><strong>Teamwork.</strong> 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.</p><p><strong>Safety &amp; Quality.</strong> 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.</p>

12 Social Services Jobs in California