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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 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

L.A. Care Health Plan

Payment Integrity Nurse Coder RN III

<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

DescriptionAt&nbsp;ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.Job Summary<ul><li>The Registered Nurse (RN) – Medical/Surgical provides safe, effective, and compassionate patient care using the nursing process of assessment, planning, intervention, and evaluation in an acute care hospital setting</li><li>The RN collaborates with the interdisciplinary team, patients, and families to achieve optimal patient outcomes, ensuring care is delivered in accordance with standards of professional nursing practice, hospital policies, and regulatory requirements</li></ul>Essential Functions<ul><li>Performs comprehensive assessments and reassessments to determine nursing care needs</li><li>Develops, implements, and evaluates individualized plans of care</li><li>Administers medications and treatments in accordance with policy and physician orders</li><li>Documents assessments, interventions, outcomes, and patient education timely and accurately</li><li>Provides direct care including ADLs, hygiene, nutrition, and mobility support</li><li>Monitors patient conditions and communicates significant changes to the care team</li><li>Collaborates with interdisciplinary team for care coordination, discharge planning, and referrals</li><li>Provides emotional and psychosocial support to patients and families</li><li>Ensures patient safety through adherence to infection control and fall prevention protocols</li><li>Supervises and delegates tasks appropriately to licensed and unlicensed staff</li></ul>Knowledge/Skills/Abilities/Expectations<ul><li>Proficient in clinical assessment, documentation, and patient care planning</li><li>Knowledge of medical terminology, pharmacology, and nursing best practices</li><li>Strong interpersonal, communication, and organizational skills</li><li>Ability to function effectively in high-stress situations with diverse patient populations</li><li>Familiarity with electronic medical records (EMR) and clinical documentation systems</li><li>Ability to lift up to 50 lbs and perform extended standing, walking, and physical activity</li><li>Demonstrates professional integrity, accountability, and a commitment to continuing education</li></ul> QualificationsEducation<ul><li>Associate degree in Nursing required</li><li>Bachelor of Science in Nursing (BSN) preferred</li></ul>License/Certification<ul><li>Current state RN license or compact state equivalent required</li><li>Basic Life Support (BLS) required per facility policy</li><li>Advanced Cardiovascular Life Support (ACLS) required per facility policy</li><li>Crisis Prevention Intervention (CPI) required per facility policy</li><li>Specialty certification (e.g., RN-BC, CMSRN) preferred</li></ul>Experience<ul><li>Minimum of 6 months of Medical/Surgical nursing experience in an acute care setting preferred</li><li>Demonstrated critical thinking, decision-making, and effective prioritization in a fast-paced environment</li></ul>

St. Francis-Emory Healthcare

Registered Nurse Telemetry, FT days

Title Case Manager&nbsp; About the Organization Concern Housing is a non-profit agency committed to helping individuals and families to live in the community with dignity and enhanced opportunities through the provision of housing and support services. We are one of the largest housing agencies of this kind in New York State, currently serving approximately 1,300 individuals and families in over 240 locations. Concern offers a variety of housing options with individualized support services designed to support personal growth and independence. Our workplace culture thrives by embracing diversity and rewarding innovative ideas. Diversity at our agency means fostering a workplace in which individual differences are recognized, appreciated, respected and responded to in ways that fully develop and utilize each person's talent and strengths.&nbsp; Position Case Manager, CR&nbsp; Full-Time/Part-Time Full-Time&nbsp; Location Shoreham East&nbsp; Salary $50,000&nbsp; Days/Hours Monday - Friday; 9am - 5pm&nbsp; Description Concern Housing is seeking a Case Manager to be responsible for providing case management services directly to clients.&nbsp; The Case Manager is considered a resource in that they should be familiar with community resources and services to which they may help their clients gain access.&nbsp; The Case Manager is also an advocate for their clients. Duties and Responsibilities:<ul><li>Provide case management services (service planning medication monitoring, assistance incoming linkages and/or referrals to clinical services, day programs, vocational services and opportunities, community integration, entitlements etc.)</li><li>Provide individual counseling and support services; responsible for all documentation.</li><li>Provide housing services including assistance with maintenance issues.</li><li>Provide daily living skills training.</li><li>Perform monthly fire safety inspections.</li><li>Attend staff meetings as scheduled.</li><li>Provide specific on-site responsibilities:&nbsp; medication monitoring, oversight of client chores, help maintain safety and cleanliness of site.</li><li>Remain current with all Agency required compliance documents and trainings.</li></ul> Salary: $50,000 &nbsp; Position Requirements Bachelor’s Degree preferred in Psychology, Rehabilitation, Social Work or other related mental health discipline preferred plus 2 years’ experience working in a similar setting and/or working with people with mental illnesses.&nbsp; The individual in this position must have good verbal and written communication skills as well as the ability to make sound judgments regarding client care. Concern Housing offers a generous benefit package which includes; Medical Insurance (Agency pays 80% of the premium), Affordable Voluntary Dental and Vision Insurance, Flexible Spending Accounts, Agency Sponsored Retirement Plan, Employee Sponsored 403(b) Retirement Plan, Agency Sponsored Life Insurance Coverage and an Excellent Paid Time Off Package. Concern encourages employee growth, offering Educational Assistance and Scholarship Programs, Licensure Reimbursement and Possible Internship/Clinical Supervision. Referral Bonuses are also available!&nbsp; EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.&nbsp; This position is currently accepting applications. Apply Now

Concern Housing

Case Manager

The RN Charge Nurse is responsible for overseeing nursing services each shift and functions as a nursing supervisor. This position provides daily supervision of staff on duty during operational hours.Essential Duties and Responsibilities include the following. Other duties and tasks may be assigned.<ul><li> Assist with clinical and operational processes to improve patient health and minimize hospitalizations and missed treatments.</li><li> Demonstrate effective use of supplies and staff labor hours.</li><li> Complete and document monthly review of patient medication profiles. Administer medications as ordered by the physician.</li><li> Assist physician during patient rounds and transcribe and implement physician orders timely.</li><li> Assist with the implementation of anemia management and medication protocols as requested.</li><li> Knowledge of and comply with federal, state, local laws and regulations, including health care professionals practice act requirements.</li><li> Perform duties at all times within limitations established by and in accordance with company policy and procedures, applicable state and federal laws and regulations.</li><li> May give direct patient care to the extent of performing efficient, safe dialysis, if allowed by state regulations.</li><li> Responds to all emergencies in clinic.</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> Maintain collaborative working relationship with Medical Director and physicians.</li><li> Participate as a member of the Interdisciplinary team in all required patient assessment and care planning activities.</li><li> Assist in orientation of new staff as a preceptor or in assigning a preceptor.</li><li> Acts as resource person and participates in implementing and evaluating dialysis services and assures that policies and procedures are updated.</li><li>Assists Administrator in interviewing, hiring, evaluating, and disciplinary actions of center staff</li></ul>

Dialysis Registered Nurse - Charge

Dialysis Registered Nurse - Floater

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.<ul><li>A Home Therapy nurse trains home hemo or peritoneal dialysis patients in-center and sometimes in the patient’s home.</li><li>We Will Train - In-center hemodialysis, critical care, and home health are great backgrounds.&nbsp; </li><li>Work Schedule – Monday through Friday, 8am to 5pm; Modified schedules are possible based on patient caseload at the facility.</li><li>Competitive on-call pay when placed in on-call rotation. </li><li>Holidays – Home Training Nurses rarely work on a holiday. </li><li>We lead the industry in clinical quality improvement, delivering amongst the best patient outcomes in the U.S. as measured by the CMS ESRD Quality Incentive Program.</li><li>We remain an industry leader in home dialysis with 17% of dialysis treatments delivered in our patients' homes.&nbsp;</li></ul>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

Dialysis Registered Nurse, Home Hemo & Peritoneal RN - Covers patients at Fairfax Home and Woodbridge Home

Dialysis Registered Nurse TTS

Please note this position is working in Caron's Women's units.Caron is one of the leading treatment centers in the US and is recognized for high-quality, evidence-based methods and thought leadership in addiction medicine. Mentored by respected experts in the field and ranked among Newsweek’s Best Treatment Centers in PA five years in a row, Caron has built a culture that supports and sustains trauma-informed, resilient staff at all levels of the organization and values personal and professional growth. We invest in our employees, providing financial plans, generous Paid Time Off programs, paid holidays, 401K employer match, tuition reimbursement, employee assistance programs, and benchmarking to ensure ongoing competitive compensation. Full-Time employee benefits also include comprehensive medical, dental, and vision benefit packages with wellness plan reduced insurance premiums and company-paid life and disability insurance. Apply today to begin a rewarding career with us.DUTIES AND RESPONSIBILITES:&nbsp;<ul><li>Oversees coordination of a patient’s care while in residential services, including the integration of family sessions, school expectations, communication with referral sources, assessment of patient progress and communication to the clinical team regarding special treatment needs and procedures. &nbsp;</li><li>Completes initial patient assessments such as psychosocial assessment, gathering patient goals and completing family assessments.&nbsp;&nbsp;</li><li>Utilize the multi-disciplinary treatment team to determine appropriate level of care and to identify behavioral health needs that can be treated in Caron’s continuum as well as those that require external placement.</li><li>Facilitates group therapy and individual counseling.</li><li>Work&nbsp;with the Family Therapist to assess family dynamics and recommend the family education program and ongoing family therapy. Develops a comprehensive continuing care plan that includes input from the clinical referents, internal referents, multi-disciplinary treatment teams, family, and patient.&nbsp;&nbsp;</li><li>Works within the ethical constraints of the certified addiction counselor and other professional or organizational ethical standards as they apply to the position.&nbsp;</li><li>Document treatment plans, progress notes, treatment plan updates, case consultations, telephone calls and discharge summaries in the patient electronic health record in accordance with Caron policies and procedures.&nbsp;</li><li>Completes necessary utilization review information.&nbsp;&nbsp;</li><li>This position will work on units throughout Core and Signature programs based on census and staff coverage needs.</li><li>This job description reflects management’s assignment of essential functions; it does not prescribe or restrict the duties or tasks that may be required or assigned.&nbsp;</li></ul>&nbsp;PHYSICAL REQUIREMENTS:&nbsp;&nbsp;The physical and mental demands described here are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.&nbsp;&nbsp;<ul><li>Must be able to work extended hours and travel as needed</li><li>Must be able to deliver presentations that may be both multiple times and for lengthy time periods&nbsp;</li><li>Must be able to lift up to 20 lbs.&nbsp;</li><li>Must be able to move throughout Caron properties&nbsp;&nbsp;</li><li>Must be able to ascend and descend stairs&nbsp;</li><li>This is a safety sensitive position&nbsp;</li></ul>&nbsp;EDUCATION / EXPERIENCE QUALIFICATIONS:&nbsp;&nbsp;<ul><li>Master’s degree in chemical dependency, psychology, social work, counseling or other related field which includes a practicum in a health or human services agency, preferably in a drug and alcohol setting OR bachelor's degree in chemical dependency, psychology, social work, counseling or other related field and 1 year of clinical experience (a minimum of 1,820 hours) in a health or human service agency, preferably in a drug and alcohol setting.</li><li>Preferred Specialty Training (i.e., MI, DBT, MBSR, CPT, CBT, EMDR, Trauma and Rainbow Advocacy)&nbsp;</li><li>Experience in lifespan developmental issues for their respective populations&nbsp;</li><li>Experience in facilitating group therapy preferred&nbsp;</li><li>Must possess a valid PA driver’s license and must comply with ACT 33 of Pennsylvania law to work with youth populations, when applicable&nbsp;</li><li>If in recovery, two years of uninterrupted sobriety preferred&nbsp;</li></ul>&nbsp;KNOWLEDGE, SKILLS AND ABILITIES:&nbsp;&nbsp;<ul><li>Must possess a basic understanding of addiction and addiction interaction disorders.</li><li>Ability to work with individuals and family members from various socioeconomic, cultural, ethnic, educational, and other diversified backgrounds utilizing counseling skills.&nbsp;</li><li>Ability to assess the psychosocial functioning and needs of individuals and their family members, and to formulate and implement a treatment plan, identifying the individual’s problems, strengths, weaknesses, coping skills, and assistance needed&nbsp;</li><li>Ability to implement treatment modalities in working with individuals, families, and groups to achieve treatment goals. This requires judgment and skill in utilizing supportive, problem solving, or crisis intervention techniques.&nbsp;</li><li>Ability to establish and maintain effective working relationships and communicate with patients, staff, and representatives of community agencies.&nbsp;</li><li>Fundamental knowledge of mental health diagnoses, disabilities, and treatment procedures to include common medications and their effects/side effects.&nbsp;</li><li>Must possess the willingness and capacity for growth, both personally and professionally.&nbsp;</li><li>Must have the ability to be objective, empathetic while addressing the individual needs of the respective patients, referrals, and family members.&nbsp;</li><li>Must be computer literate and able to work with most Microsoft applications along with network components.&nbsp;</li><li>Must have fluid communication skills and the ability to document insights and observations in a clinical record.&nbsp;</li><li>Must possess a high degree of professionalism and be able to keep confidential information and treat sensitive clinical information ethically.&nbsp;&nbsp;</li><li>Must be able to keep all clinical work within the guidelines of licensure, accreditation and Caron standards throughout his/her work.&nbsp;</li><li>Must be thoroughly familiar and be able to demonstrate knowledge of the principles and programs of the various 12 step fellowships.&nbsp;</li><li>Must possess effective written and verbal communication skills.&nbsp;</li></ul>#IND102

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