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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

Dialysis Registered Nurse MWF

<p>Salary Range:&nbsp;&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&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 in five health plans, 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 Clinical Assurance Compliance Nurse Specialist RN II is responsible for the review of regulatory, contractual and accreditation standards to ensure Health Care Services Department policies are in compliance and in operation. The position works closely with Regulatory Affairs and Compliance to ensure timely exchange of documentation to evidence compliance. The position is responsible for the internal auditing process for referral management and complex case management using approved auditing/monitoring tools. This position participates in the review and presentation when necessary of training materials for external delegates and internal staff training.&nbsp;</p><h4>Duties</h4><h4>Assist in the continual maintenance of Health Services Policies/Procedures, letter templates, Workflows, Process, Audit Tools and Training Materials in compliance with regulatory requirements, new legislation and accreditation standards. Work collaboratively with Regulatory Affairs &amp; Compliance to ensure Health Services Departments are made aware and department documents updated accordingly.</h4><h4>Develop and maintain Medical Management training materials in compliance with all regulatory requirements, new legislation, and accreditation standards. Assist in the preparation of the Health Services Departments for review by external regulatory and accrediting bodies (Department of Health Care Services (DHCS), A&amp;I, DHCS Member Rights, Department of Managed Health Care (DMHC), National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services(CMS)) and internally for audits by Real Application Clusters (RAC) through team processes. </h4><h4>Assist in the development and revisions of audit tools, Policies, provider trainings to improve compliance with regulatory and accreditation standards. Develop and implement procedures to assurance compliance with care coordination and documentation of Utilization Management (UM) and CM element.</h4><h4>Provide training, education and consultation as necessary to delegates. Collaborate with other UM staff on identifying topics and developing agendas for the JOMs/performance visits/communications. </h4><h4>Maintain confidentiality in compliance with all Health Insurance Portability and Accountability Act (HIPAA) requirements. Assist co-workers with special projects or work volume as required. Actively identify and implement efforts to improve the quality, effectiveness and efficiency of job functions.&nbsp;&nbsp; </h4><h4>Communicate to supervisors any barriers to completing assignments or daily work with delegates in an efficient and effective manner. Demonstrate reliability and good attendance and punctuality standards.</h4><p>Perform 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>Required:</p><p>At least 5 years of experience in a clinical setting and managed care plan performing UM oversight, including auditing.</p><p>Managed Health Care experience.</p><h4>Skills</h4><p>Required:</p><p>Good working knowledge of licensure and regulatory requirements, and accreditation standards.</p><p><br>Ability to manage and organize large volumes of data.</p><p>Knowledge of regulatory and accreditation entities and their requirements.</p><p>Excellent verbal and written communication skills; excellent interpersonal skills.</p><p>Proficient in MS Office applications.</p><p>Ability to work independently. Ability to solve complex problems/issues and identify creative solutions.</p><p>Knowledge of issues pertaining to Medi-Cal, Medicare, and other Health Maintenance Organization (HMO) &amp; Independent Practice Association (IPA) contracts and payers.</p><h4>Licenses/Certifications Required</h4>Registered Nurse (RN) - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4>Certified Professional in Utilization Review (CPUR)Certified Case Manager (CCM)Certified Professional in Healthcare Quality (CPHQ)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>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.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</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>

L.A. Care Health Plan

Clinical Assurance Compliance Nurse Specialist RN II

<p>Salary Range:&nbsp;&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&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 in five health plans, 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 Utilization Management Clinical Quality Nurse Reviewer RN II, under the purview the Utilization Management (UM) Department Leadership Team, is responsible for conducting and tracking targeted and random internal department documentation audits. This role is ensures that UM practices and supporting documentation are compliant with all regulatory requirements. &nbsp;The Incumbent also serves as a Subject Matter Expert during external audits as well as leads pre- and post-audit preparation/follow-up.&nbsp; This position actively participates in development and review of policies and procedures to certify compliance with regulatory guidelines and mandates. This position will focus on UM cases for all lines of business to identify areas of opportunity for increasing positive audit outcomes and improved service to L.A. Care’s membership. This position is responsible for identifying and monitoring staff (non-clinical, nurse, and physician) performance against key performance indicator trends that warrant recognition or remediation. This position performs data mining and analysis and create reports on audit findings, as well as make recommendations, to submit to the department's Quality Assurance Team and UM Management.</p><h4>Duties</h4><p>Facilitates the development, review, and revision of organizational and departmental process flows to ensure compliance with relevant regulatory, organizational, and departmental guidelines.</p><p>Keenly focuses on practices and documentation of clinical staff, serving as a resource on state and federal industry mandates applicable to UM functions.</p><p>Generates results of findings, enhances, and analyzes various reports related, but not limited to, quality and accuracy of case documentation.&nbsp;</p><p>Works with department leadership to assess for all opportunities related to quality improvements.&nbsp;</p><p>Compiles and presents quality report cards that measure adherence to quality and regulatory compliance.&nbsp;</p><p>Keeps UM Leadership apprised of departmental and industry trends, deficiencies, and any potential risks, and collaborates with the team to develop and execute mitigation efforts.</p><p>Serves as a consultant to the organization's Compliance team on an ad hoc basis.</p><p>Performs other duties as assigned.&nbsp;</p><h4>Duties Continued</h4><h4>Education Required</h4>Associate's Degree in Nursing<h4>Education Preferred</h4>Bachelor's DegreeMaster's Degree in Nursing<h4>Experience</h4><p>Required:&nbsp;<br>At least 5 years of experience in Clinical Nursing. Minimum of 2 years of auditing clinical documentation. &nbsp;Active participation in at least two state regulatory audits and one federal regulatory audits. Previous experience with Medi-Cal and Medicare in a managed care environment and experience with mitigation planning and implementation.</p><p>Preferred: &nbsp;<br>Experience performing clinical documentation for a health plan. Active participation in at least three state regulatory audits, at least one National Committee for Quality Assurance (NCQA) audit and/or Centers for Medicare and Medicaid Services (CMS) audit. &nbsp;Background in teaching and/or clinical education.</p><h4>Skills</h4><p>Required:&nbsp;<br>Superior verbal and written communication skills.&nbsp;</p><p>Advanced computer proficiency in both Microsoft Word and Excel.&nbsp;</p><p>Strong analytical and team building skills.&nbsp;</p><p>Ability to work independently and be self-directed.&nbsp;</p><p>Ability to work effectively with diverse team members.&nbsp;</p><p>Strong problem-solving skills.&nbsp;</p><p>Ability to multitask and streamline day-to-day operations.&nbsp;</p><p>Ability to translate regulatory requirements into auditable tools.&nbsp;</p><p>Preferred:</p><p>Proven ability to lead successful performance improvement projects.</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>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.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</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>

Utilization Management Clinical Quality Nurse Reviewer RN II

<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>

Dialysis Registered Nurse PRN

<p>Salary Range:&nbsp;&nbsp;$67,186.00&nbsp;(Min.) -&nbsp;$87,342.00&nbsp;(Mid.) -&nbsp;$107,498.00&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 in five health plans, 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><br>The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II is primarily responsible for the overall coordination of the Appeals &amp; Grievance program for L.A. Care Health Plan members under the direct supervision and management of the A&amp;G Nurse Specialist, RN and/or Medical Director. This position provides assistance to members with health care access and benefit coordination issues, ensuring that clinical grievances and complex issues are investigated and resolved to the member’s satisfaction consistent with L.A. Care Health Plan and regulatory guidelines. Benefit coordination may involve coordinating multiple L.A. Care Health Plan Lines of Business.&nbsp;</p><h4>Duties</h4><p>Works with Registered Nurses and Medical Directors to appropriately investigate, review and resolve clinical appeals and grievances. Prepares Nurse Summary for MD review and determination. Performs clinical review of medical records related to grievances and appeals. Responsible for handling member and provider appeals providing clinical reviews and write-ups and recommendations, mailing and faxing of resolution letters.</p><p><br>Reviews grievance cases that require immediate clinical quality of care, initial coding of member grievance and evaluation and/or require immediate pre-service authorization evaluation.</p><p>Investigates Provider Disputes/PDR and prepares clinical summary for Medical Director determination.&nbsp;</p><p>Work with the external providers and PPGs representatives to obtain relevant medical records and communication documentation.</p><p>Investigation and preparation of State Fair Hearing cases as assigned.</p><p>Prepare resolved complaint files for Centers for Medicare and Medicaid Services(CMS), external review organization (QIO or IRE).</p><p>Work with Utilization Management and PNO to facilitate completion of resolution determination.</p><p>Investigate, prepare summary and work with Medical Directors to resolve expedited cases within regulatory timelines. Maintain knowledge of regulatory changes related to all grievances and appeals and meets regulatory requirements. Refers cases for further follow-up or notification as appropriate, e.g. fraud and abuse cases shall be forwarded to Compliance Department.</p><p>Perform other duties as assigned.</p><h4>Duties Continued</h4><h4>Education Required</h4>Associate's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p><strong>Required:</strong><br>At least 4 years of clinical nurse and managed care experience.</p><h4>Skills</h4><p><br><strong>Required:</strong><br>Excellent interpersonal and communication skills.&nbsp;</p><p>Good working knowledge of regulatory requirements/standards.&nbsp;</p><p>Computer literacy and adaptability to computer learning.&nbsp;</p><p>Time management and priority setting skills.</p><p>Must be organized and a team player, able to work effectively with various internal business units, Plan Partners, participating provider groups, and external agencies.</p><h4>Licenses/Certifications Required</h4>Licensed Vocational Nurse (LVN) - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><p><strong>Required:</strong><br>License Vocational Nursing (LVN)</p><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>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.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</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>

Customer Solution Center Appeals and Grievances Nurse Specialist LVN II

<p>Job Description:</p><p>POSITION SUMMARY:</p><p>The Enrollment Counselor position at Pacific Oaks supports all recruitment, admissions, and advising efforts at the college. Additionally, it helps with activities by handling communications, information, and paper flow with prospective and admitted students. The successful candidate will be an articulate, organized, results-driven, dynamic, enthusiastic, and collaborative member of the team.</p><p>This position is located in Pasadena and reports directly to the Director of Admissions</p><p>SUPERVISION RECEIVED:</p><p>The incumbent performs a variety of routine work within established policies and procedures and receives detailed instructions on new projects and assignments.</p><p>SUPERVISION EXERCISED:</p><p>Minimal or no supervisory responsibilities.</p><p>ESSENTIAL FUNCTIONS:</p><ul><li>Provide excellent customer service to prospective students throughout the full admission recruitment process</li><li>Meet daily expectations for outbound dials, set campus consultations</li><li>Meet with prospective students to counsel on completing Admissions requirements, discusses academic programs, admission options, and financial aid opportunities and conducts campus tours.</li><li>Meet/exceed Admission benchmark goals</li><li>Availability to work evening shifts and a rotating Saturday shift as needed</li><li>Follow up with prospects and applicants by phone and written correspondence.</li><li>Plan and coordinate on-campus Information Sessions and Open Houses for prospective students</li><li>Regularly attends the school department staff meetings</li><li>Assist new and continuing students with registration process</li><li>Follow up with admitted/current students to ensure they maintain part-time/full-time status</li><li>Liaise with corresponding departments to support the admissions team</li><li>Ensure students meet with Faculty Advisors to outline program completion plans</li><li>Track and document all communication with Inquiries, applications and students through Salesforce and Campus Vue</li><li>Contributes to a work environment that encourages knowledge of, respect for, and development of skills to engage with those of other cultures or backgrounds.</li><li>Perform other duties as assigned.</li></ul><p>Is regular attendance an essential function?&nbsp; ☒ Yes&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ No</p><p>ESSENTIAL KNOWLEDGE, SKILLS and ABILITIES:</p><p>Knowledge:</p><ul><li>Sales Expertise: Proficient in sales and account management.</li><li>Program Knowledge: Familiarity with CFP, HD, SOE programs, and state licensure requirements.</li></ul><p>Skills:</p><ul><li>Consultative Approach: Skilled in addressing concerns and assisting with enrollment decisions.</li><li>Communication Skills: Excellent written and verbal communication.</li></ul><p>Abilities:</p><ul><li>Goal-Oriented: Accountable for meeting monthly goals and performance expectations.</li><li>Relationship Building: Effective in establishing rapport with prospective students.</li><li>Time Management: Strong organizational and multi-tasking abilities.</li><li>Independent and Collaborative: Capable of working both independently and collaboratively in a fast-paced environment.</li></ul><p>PREFERRED KNOWLEDGE, SKILLS, AND ABILITIES:</p><p>Knowledge:</p><ul><li>Non-Traditional Students: Experience with non-traditional student populations.</li><li>Credentialing Information: Knowledge about credential program information and school credentialing requirements.</li><li>Industry Knowledge: Familiarity with the education sector.</li></ul><p>Skills:</p><ul><li>Professional Interaction: Skilled in networking and group presentations.</li><li>Inquiry Management: Effective in generating and following up on inquiries.</li><li>Public Speaking: Excellent presentation skills.</li></ul><p>Abilities:</p><ul><li>Self-Motivated: Goal-oriented and proactive in recruiting students.</li><li>Event Coordination: Proficient in planning logistics and coordinating events.</li><li>Consistent Performance: Proven track record of consistent results.</li><li>Admissions Guidance: Experienced in enrollment and academic advising.</li><li>Positive Attitude: Promotes a healthy work environment.</li><li>Travel and Flexibility: Willing to travel and work flexible hours, including evenings and weekends.</li></ul><p>POSITION QUALIFICATIONS:</p><ul><li>Education: Bachelor’s degree or equivalent years of related experience required</li><li>Experience: Minimum of 1 year of college admissions, recruitment or sales required; non-traditional higher education recruitment or sales experience preferred.</li></ul><p>TYPICAL WORKING CONDITIONS</p><ul><li>Office environment; typically, 70 degrees</li><li>Noise level is usually quiet to moderately noisy while in the office</li></ul><p>EQUIPMENT USED:</p><ul><li>Computer/Laptop</li></ul><ul><li>Telephone</li><li>Copier, scanner and fax machines</li></ul><p>ESSENTIAL PHYSICAL &amp; MENTAL TASKS: (Check all that apply):</p><p>Physical Demands: </p><p>☒ Standing&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Lifting:&nbsp; 10 Lbs.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Pushing/Pulling&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Driving</p><p>☐ Walking&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Carrying&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Hearing&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Speaking</p><p>☐ Reaching&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Writing &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Squatting/Kneeling&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Seeing</p><p>☐ Climbing&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Pushing&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Other:&nbsp; Typing</p><p>Physical Environment - Exposed to:&nbsp; </p><p>☒ Noise&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Heat/Cold&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Fumes/Gases&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Human Tissue/Fluids</p><p>☐ Chemicals&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Carcinogens&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Dirt&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Animal Tissue/Fluids</p><p>☐ Toxic Chemicals&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Radiation&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐Other:&nbsp;</p><p>☐ Biohazardous Material</p><p>Mental Demands:&nbsp; </p><p>☒ Reading&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Frequent Interruptions&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Periods of Concentrated Attention&nbsp;&nbsp;&nbsp;</p><p>☒ Detailed Work&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Irregular Work Schedule&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Frequent Contact with People</p><p>☒ Frequent Deadlines&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐Other:&nbsp;</p><p>☒ Multiple Concurrent Tasks</p><p>TRAVEL: (% of total time): Up to 5% of total time</p><p>ENVIRONMENTAL CONDITIONS:</p><p>The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job:&nbsp;</p><p>The noise level in the work environment is usually quite to moderately noisy while in the office.&nbsp; The office temperature is about 70 degrees.</p><p>DECISION MAKING:</p><p>The position is governed by the policies of Pacific Oaks, along with established procedures for the department.</p><p>CONTACT RESPONSIBILITIES:</p><p>Routine exchange or presentation of information.</p><p>Responsible for demonstrating professionalism and leadership in resolving conflicts with students and employees.&nbsp; Recommends alternative approaches to solve problems and conflicts.&nbsp;</p><p>FINANCIAL RESPONSIBILITY:</p><p>This position does not require the management of budgets, but it is required to follow Pacific Oaks policies for purchasing and budget approvals.</p><p>Compensation &amp; Benefits</p>This opportunity is budgeted at $20.00-21.50 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.pacificoaks.edu/about/careers-pacific-oaks/" target="_blank">https://www.pacificoaks.edu/about/careers-pacific-oaks/</a></p><p>Pacific Oaks is an Equal Opportunity Employer.</p><p>Pacific Oaks participates in E-Verify and verifies identity and employment eligibility of all persons hired.<br></p><p><i>The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. Pacific Oaks offers equal employment opportunities to all persons without regard to race, color, ethnicity, religion, sex, sexual orientation, national origin, age, marital status, physical or mental disability, parental status, housing status, source of income or military status, in accordance with applicable federal, state and local EEO laws.</i></p>

Pacific Oaks Children’s School

Enrollment Counselor

Dialysis Registered Nurse TTS | Will Train

<p>Salary Range:&nbsp;&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&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 in five health plans, 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 Utilization Management Nurse Specialist RN II will facilitate, coordinate, and approve medically necessary referrals that meet established criteria. Assures timely and accurate determination and notification of referrals and reconsiderations based on the referral determination status. Generates approval, modification and denial communications, to include member and provider notification of referral determination. Actively monitors for admissions in any inpatient setting. Performs telephonic and/or on site admission and concurrent review, and collaborates with onsite staff, physicians, providers, member/family interaction &nbsp;to develop and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service, concurrent, post-service and retrospective claims medical review. Monitors and oversees the collection and transfer of data (medical records) and referral requests by Providers. Acts as a department resource for medical service requests /referral management and processes. Receives incoming calls from providers, professionally handles complex calls, researches to identify timely and accurate resolution steps. Follows up with caller to provide response or resolution steps. Answers all inquiries in a professional and courteous manner.</p><h4>Duties</h4><p>Promote and support team engagements, programs and activities to create and ensure a positive and productive workplace environment.</p><p>Perform telephonic and/or on site admission and concurrent review, and collaborates with onsite staff, physicians, providers, the member and significant others to develop and implement a successful discharge plan. Process, finalize and facilitate Inbound requests that are received from providers.&nbsp;</p><p>Generate appropriate member and provider communication for all determinations within the required timelines as defined by the most current department policy.</p><p>Facilitate/review requests for Higher level of care or skilled nursing/discharge planning needs. &nbsp;Research for appropriate facilities, specialty providers and ancillary providers to utilize for all lines of business. Identification of potential areas of improvement within the provider network.<br><br>Identify and initiate referrals for appropriate members to the various L.A. Care programs/processes and external community based programs or Linked and Carve Out Services (e.g. DDS/CCS/MH). Potential quality of care/potential fraud issues are identified and documented per L.A. Care policy. High risk/high cost cases and reports are maintained and referred to the Physician Advisor/UM Director.&nbsp;<br>Documents in platform/system of record. Utilizes designated software system to document reviews and or notes.&nbsp;</p><p>Receive incoming calls from providers, professionally handles complex calls, researches to identify timely and accurate resolution steps. Follows up with caller to provide response or resolution steps. Answers all inquiries in a professional and courteous manner.</p><p>Perform other duties as assigned.&nbsp;</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>Required:<br>At least 5 years of varied clinical experience in an acute hospital setting. At least 2 years Utilization Management/Case Management experience in a hospital or HMO setting .&nbsp;</p><p>Preferred:<br>Managed Care experience performing UM and CM at a medical group or management services organization.</p><p>Experience with Managed Medi-Cal, Medicare, and commercial lines of business.</p><h4>Skills</h4><p>Required:<br>Must be computer literate, with expertise in Outlook, Word, Excel, PowerPoint. &nbsp;Effectively utilizes computer and appropriate software and interacts as needed with L.A. Care Information System. Knowledge of personal computer, keyboarding, and appropriate &nbsp;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;</p><p>Provision of excellent customer service required due to frequent communication with providers and other members of the interdisciplinary team &nbsp;<br><br>Excellent time management and priority-setting skills.</p><p>Maintains strict member confidentiality and complies with all HIPAA requirements.</p><p>Strong verbal and written communication skills. &nbsp; &nbsp;</p><p>Preferred:<br>Knowledge of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or Care Management (CM).&nbsp;</p><p>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.</p><h4>Licenses/Certifications Required</h4>Registered Nurse (RN) - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4>Certified Case Manager (CCM)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><br>May work in occasional weekends and some holidays depending on business needs&nbsp;</p><p>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.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</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>

12 Social Services / Nursing Jobs in Los Angeles, CA, USA