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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

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

<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 - 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

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 Charge Nurse

Dialysis Registered Nurse

Our Per Diem&nbsp;requirements are one weekend shift per month as well as one holiday per year.&nbsp;Duties and Responsibilities:<ul><li>Assume the charge nurse role if applicable and/or unit nurse role by:</li><li>Receiving and giving accurate and thorough shift reports</li><li>Keeping the physicians informed of patient’s conditions, change of conditions, LOC and triage information and needs</li><li>Correctly entering and taking off physician orders</li><li>Oversight of the care of patients by auxiliary personnel</li><li>Organizing and delegating patient care activities</li><li>Monitoring and/or performing diagnostic screening tests as ordered by physician</li><li>Providing thorough and accurate patient information during shift exchange for end of shift report</li><li>Assess individual patient care needs, initiate medical treatment plan and competently implement/instruct all care in the appropriate nursing practice to all staff.</li><li>Serve as a resource to treatment team members.</li><li>Perform nursing assessments, LOC, and review patient histories to document all necessary information in the Electronic Medical Record on all patients admitted to Caron.</li><li>Prepare patients for examinations: height/weight, vitals, collect and process lab specimens including UDS, UA, Chem Sticks, etc. following proper infection control procedures.</li><li>Utilize safe and effective practices of medication management as defined by policy including the oversight of self-administration observation of medication.</li><li>Administer and monitor the effects of medications, ensure accurate medication is ordered and administered for controlled substances and conduct accurate med counts.</li><li>Provide appropriate patient education as determined by patient assessments/needs and treatment plans.</li><li>Conduct 14-day, 25-day and PRN meetings with patients for assigned units when in unit nurse role.</li><li>Monitor and/or perform withdrawal assessments and appropriately implement/instruct the necessary nursing interventions.</li><li>Accurately and thoroughly document in the medical record utilizing approved medical record language and abbreviations adhering to the medical record policies and procedures.</li><li>Schedule all patient appointments related to their medical treatment.</li><li>Work a flexible schedule based upon service demands and work mandatory overtime as needed.</li><li>Attend all mandatory trainings as identified by Caron policies.</li><li>Attend multi-disciplinary treatment team meetings when in unit nurse role.</li><li>Maintain the quality control logs.</li><li>Provide support services for patient care issues to staff at other Caron facilities.</li><li>Maintain adequate staffing for each shift.</li><li>Ensure the highest level of professionalism for self and staff and maintain a clean and organized work environment.</li><li>Complete yearly training requirements and mentor new employees.</li><li>This job description reflects management’s assignment of essential functions and does not prescribe or restrict the tasks that may be assigned.</li></ul>Physical Requirements:The physical and mental demands described here are representative of those that must be met to successfully perform the essential functions of this job.&nbsp; Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.<ul><li>Lifting: up to 50 pounds on occasion.</li><li>Standing: up to several hours at a time, this may include walking, climbing steps, and descending steps.</li><li>Walking: must be able to ambulate throughout the assigned facilities on campus or Caron properties.</li><li>Sitting: up to several hours at a time for data entry into the computer or medical record documentation.</li></ul>EDUCATION/EXPERIENCE QUALIFICATIONS:<ul><li>Currently licensed as RN or LPN in Pennsylvania.</li><li>Current Certified Addiction Registered Nurse (CARN) certification preferred.</li><li>1-3 years’ experience working as an RN or LPN preferably in ER, acute care or mental health setting</li><li>Current CPR/First Aid training/certification.</li><li>21 years of age or older is required</li><li>Requires a current, valid, unrestricted driver’s license</li><li>Two years continuous sobriety preferred if in recovery.</li><li>Previous hospital/chemical dependency rehabilitation treatment program experience desired.</li><li>Possess a working knowledge of addictions with age specific patient populations preferred.</li><li>Working knowledge of electronic medical record and charting.</li></ul>

Caron Treatment Centers

Registered Nurse (RN) - Per Diem

The hiring range for this role is: &nbsp;$103,676.95 - $159,759.88This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.&nbsp; We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.&nbsp;This job is also eligible for annual bonusincentivepay.We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.Responsible for overseeing all Utilization Management (UM) and Medical Policy deliverables within the organization. This includes identification, implementation, oversight, management, and evaluation of UM and Medical Policy program functions and initiatives. Serves as a clinical and technical expert, provides technical guidance and education to internal and external business partners regarding UM and Medical Policy clinical criteria and industry standards. Conducts systematic analysis to evaluate evidence-based clinical guidelines to develop and update medical policies. Additionally, reviews and evaluates new benefits, participate in complex projects, and ensures medical policy documentation aligns with benefit design and contractual obligations, supporting program performance assessment and accreditation.<li>Act as a liaison, resource, and clinical subject matter expert to internal and external business partners. Provide guidance on utilization management and medical policy activities, ensuring the development and implementation of required strategies, programs, and products. Promote and reinforce Plans’ accountability for achieving business outcomes, while providing ongoing monitoring, evaluation, and revision of guidelines as needed 25%</li><li>Conduct systematic reviews of evidence-based reference policy documents and current clinical literature to develop and update medical policies. Ensure consistency with benefit design, contractual obligations, and program/accreditation requirements. Adhere to the medical policy review cycle schedule, lead content development for draft documents, and prepare and present medical policy content and review procedures to the Pharmacy and Medical Policy Committee for approval 25%</li><li>Manage critical escalations that have external visibility and impact member and provider satisfaction. Evaluate options and work with BCBS Plans for resolution. Identify and manage risks, resolve conflicts, and remove barriers that impede Plans’ ability to achieve goals and performance expectations 25%</li><li>Contribute to cross-functional teams by interpreting utilization data, medical coding, and policy research. Translate trend information into strategic action plans, resulting in value-added resources and programs that address business needs and support program strategic initiatives 15%</li><li>Lead background clinical research on current and emerging technology areas, including the FDA approval or clearance status of FDA-regulated products. Synthesize, summarize, and present information to internal and external business partners as the evidence basis for medical necessity and experimental/investigational determinations 10%</li> Job Overview: Responsible for overseeing all Utilization Management (UM) and Medical Policy deliverables within the organization. This includes identification, implementation, oversight, management, and evaluation of UM and Medical Policy program functions and initiatives. Serves as a clinical and technical expert, provides technical guidance and education to internal and external business partners regarding UM and Medical Policy clinical criteria and industry standards. Conducts systematic analysis to evaluate evidence-based clinical guidelines to develop and update medical policies. Additionally, reviews and evaluates new benefits, participate in complex projects, and ensures medical policy documentation aligns with benefit design and contractual obligations, supporting program performance assessment and accreditation. Essential Functions<ul><li>Act as a liaison, resource, and clinical subject matter expert to internal and external business partners. Provide guidance on utilization management and medical policy activities, ensuring the development and implementation of required strategies, programs, and products. Promote and reinforce Plans’ accountability for achieving business outcomes, while providing ongoing monitoring, evaluation, and revision of guidelines as needed</li><li>Conduct systematic reviews of evidence-based reference policy documents and current clinical literature to develop and update medical policies. Ensure consistency with benefit design, contractual obligations, and program/accreditation requirements. Adhere to the medical policy review cycle schedule, lead content development for draft documents, and prepare and present medical policy content and review procedures to the Pharmacy and Medical Policy Committee for approval</li><li>Manage critical escalations that have external visibility and impact member and provider satisfaction. Evaluate options and work with BCBS Plans for resolution. Identify and manage risks, resolve conflicts, and remove barriers that impede Plans’ ability to achieve goals and performance expectations</li><li>Contribute to cross-functional teams by interpreting utilization data, medical coding, and policy research. Translate trend information into strategic action plans, resulting in value-added resources and programs that address business needs and support program strategic initiatives</li><li>Lead background clinical research on current and emerging technology areas, including the FDA approval or clearance status of FDA-regulated products. Synthesize, summarize, and present information to internal and external business partners as the evidence basis for medical necessity and experimental/investigational determinations</li></ul>QualificationsEducation <ul><li>Required Bachelor's Degree in nursing or related field from an accredited university; or equivalent work experience</li><li>Preferred Master's Degree</li><li>Experience </li><li>5+ Years of experience with Utilization Management and Medical Policy development in a managed care setting Required</li><li>Knowledge Skills and Abilities </li><li>Excellent written and verbal communication skills Ability to translate complex, technical and/or quantitative information in clear, concise, and understandable documents of presentation Advanced project management skills for planning and executing multiple projects and a detail orientation to ensure compliance with accreditation standards and accuracy of statistics Demonstrated ability to identify and create strategies that support initiatives and translate these into strategic action plans Ability to work well in an interdisciplinary clinical team environment Demonstrated ability to foster strong working relationships with customers and business stakeholders and contact Demonstrated ability to handle multiple projects, prioritizing critical aspects/tasks, working under pressure and meeting deadlines Ability to lead independent research Technical proficiency with information technologies (e.g. Microsoft Office) and literature-search databases Demonstrated abilities in data analysis, synthesis, and reporting, including systematic analysis of clinical literature Ability to conduct comparative analysis of external medical policies, with detailed analysis of specific clinical indications Demonstrated ability to understand complex medical technology assessments and detailed analysis of specific clinical indications in medical policies</li><li>Certifications &amp; Licenses </li><li>Required: RN-CS - RN Certified Clinical Specialist -</li><li>Preferred: CPHM - Certified Professional in Healthcare Management - AIHM</li><li>Preferred: Certified Professional Coder (CPC) - AAPC</li><li>Preferred: Accredited Case Manager (ACM) - ACMA</li></ul> Extra Posting information: A minimum of four years of experience with Utilization Management and Medical Policy development in a managed care setting. Experience with URAC/NCQA accreditation requirements. Experience presenting information to large audiences (town hall calls, professional conferences, etc.), both virtually and in-person. Experience in leading cross-functional work Experience related business experience which demonstrates knowledge and understanding of PPO operations, business practices and processes, as well as knowledge of corporate goals.#LI-Hybrid

Blue Cross Blue Shield Association

Utilization Senior Program Manager (Registered Nurse)

It’s inspiring to work with a company where people truly BELIEVE in what they’re doing! When you become part of the Chapters Health Team, you’ll realize it’s more than a job. It’s a mission. We’re committed to providing outstanding patient care and a high level of customer service in our communities every day. Our employees make all the difference in our success!Role: The RN, Hospice House is responsible for assessing and identifying patient/family needs, utilizing the nursing process, coordinating the Plan of Care with the Interdisciplinary Group (IDG), and providing palliative and supportive care to the patient/family unit.Qualifications: • Current license as RN in the state providing care, current active single-state out-of-state nurse license, or current active multistate/compact nurse license • Minimum one (1) year in-patient nursing or hospice experience for external candidates; for internal applicants, minimum of 6-months of LPN experience with hospice/home health within an affiliate. New grads may be considered in IPU only. • Previous experience working with an EMR/EHR (Electronic Medical/Health Record) system preferred • Ability to use equipment with visual and auditory mechanisms • Ability to effectively communicate in English (verbal and written) • Flexible schedule to meet the needs of Hospice House patients • Ability to manage the emotional stress of working with and caring for terminally ill patients and their families • Ability to physically access patient rooms, other areas of the Hospice House/Hospital/ALF, etc., and any home (i.e., navigate stairs and narrow spaces, tolerate heat and lack of air conditioning) within any part of the service area • Ability to perform the essential functions and physical requirements (including, but not limited to: lifting patients and/or equipment, bending, pushing/pulling, kneeling) of the job with or without reasonable accommodation•&nbsp;Active BLS for healthcare professionals from the American Heart Association or Red Cross. Employees hired prior to 12/31/2022 must obtain certificate prior to 3/31/2023- Intermittent Driver – Valid driver’s license and automobile insurance per Company policy. Ability to travel off-site to meet business needs Competencies: • Satisfactorily complete competency requirements for this position. Responsibilities of all employees: • Represent the Company professionally at all times through care delivered and/or services provided to all clients. • Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse. • Comply with Company policies, procedures and standard practices. • Observe the Company's health, safety and security practices. • Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company. • Use resources in a fiscally responsible manner. • Promote the Company through participation in community and professional organizations. • Participate proactively in improving performance at the organizational, departmental and individual levels. • Improve own professional knowledge and skill level. • Advance electronic media skills. • Support Company research and educational activities. • Share expertise with co-workers both formally and informally. • Participate in Quality Assessment and Performance Improvement activities as appropriate for the position. Job Responsibilities: • Provides and manages direct care to patients and families as part of Interdisciplinary Group (IDG), incorporating psychosocial, spiritual, cultural, physical and biological components, and appropriate nursing intervention and follow-up. • Coordinates the Plan of Care, ensuring that an individualized Plan of Care is developed that accurately reflects the patient’s evolving needs. • Educates patient, family, caregivers and other health professionals about disease process and decline, palliative interventions, care giving, dying process and safety practices. • Reports changes in the patient’s condition to appropriate members of the IDG or other health professionals. • Participates with the IDG to evaluate hospice referrals/admissions for level of care appropriateness. • Attends patient deaths; prepares body for transport; oversees disposal of medications. • Provides appropriate bereavement interventions to the family and caregiver in conjunction with psychosocial staff. • Presents concise and pertinent oral and written reports to IDG; respects and encourages input from all disciplines. • Communicates accurately and completely to physicians, staff members, patients, families, and supervisors; utilizes positive approaches when working with others. • Supervises patient care given by other nursing team members (i.e., LPNs, Hospice Aides, and contract nurses). • Performs other duties as assigned.Some locations may require:<ul><li>Cross training to field (home/facility/admission) positions of equal licensure/certification and scope when hospice house census calls for flexible staffing.</li></ul> Physical Demands for Post Offer/Pre-Placement (The demands described below are representative of those that must be met by an individual to perform the essential functions of the job, with or without reasonable accommodation.): While performing the duties of this job, the following abilities are required: see; hear; talk; walk; use hands to finger, handle or feel. Frequently required to: stand; sit; reach with hands/arms; lift; bend; balance. Occasionally required to: pull; push; stoop/crouch; kneel; climb stairs.This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy.

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