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At Revere Health, we believe there is a better path to healing and healthcare maintenance, and we're working on this mission- one patient at a time. We're a national leader in a movement called value-base care which aims to improve treatment outcomes and keep cost down. Our internal culture is one that promotes respect and consistently recognizes the impact that individual employees have on the mission of the organization.Position Summary:At Revere Health, we believe there is a better path to healing and healthcare maintenance, and we’re working on this mission—one patient at a time. We’re a national leader in a movement called value-base care which aims to improve treatment outcomes and keep costs down. Our internal culture is one that promotes respect and consistently recognizes the impact that individual employees have on the mission of the organization. Position Summary: The certified nurse midwife (CNM) is an advanced practice nurse who is responsible for the assessment, plan, implementation and evaluation of nurse midwifery care delivered to antepartum, intrapartum and postpartum, and newborn patients. The CNM performs physical exams, collects and documents data, manages labor and spontaneous delivery, conducts diagnostic and therapeutic procedures, orders and schedules laboratory studies and professional consultations, and prescribes appropriate interventions and medications. The CNM also provides, as appropriate, care and education to gynecologic patients. Essential Job Functions:&nbsp;Essential Job Functions: Provides direct patient care according to approved practice guidelines in the following areas 1. Antepartum a. Collects and records historical and current medical, family social, obstetrical data; performs complete physical assessment including pelvic exam at initial AP visit b. Collects and records physical, psycho social data at each subsequent AP visit c. Requisitions appropriate laboratory or diagnostic studies d. Assesses health status of patient and determines management plan e. Consults/collaborates/refers to physicians for deviations from health as per practice guidelines f. Provides continuing supervision and education to patients 2. Intrapartum a. Reviews medical record examines and evaluates patient status and determines management plan b. Admits patient and writes orders in medical record c. Plans and provides for continuous care and support d. Manages labor, birth and postpartum recovery e. Consults with physicians appropriately f. Completes documentation in medical record 3. Postpartum a. Examines postpartum mother at least daily while in the hospital, assesses health status and records information on her medical record b. Assesses mother’s needs and assists her in plans for care for herself and her infant during the postpartum period, i.e./ hygiene, activity, warning signs, birth control, family support, care and feeding of the baby c. Arranges for follow up care, i.e., 1,2 and/or 6 week postpartum office visit d. Performs 6 week postpartum exam, updating medical/psycho social history and plans for follow up as appropriate 4. Well-woman Gynecology a. Collects historical data and performs annual physical exams b. Offers health teaching, treatment of minor gynecological problems and contraceptive services c. Consults/refers to physician for medical problems per practice guidelines d. Orders laboratory studies and writes prescriptions as appropriate other duties as assigned. Knowledge of professional nursing theory: Clinical practice standards, normal maternal / fetal growth and development, and requirements of nurse midwifery practice Able to independently seek out resources and solve complex problems Able to communicate effectively with patients, families, visitors, healthcare team, physicians, administrators, leadership, and others Able to use sensory and cognitive functions to process and prioritize information, perform health assessments, treatment, and follow-up Able to use fine motor skills Able to record activities, document assessments &amp; interventions; prepare reports and presentations Able to use computer and learn new software programs Able to provide leadership in clinical area of expertise and in meeting organizational goals Able to withstand prolonged standing and walking with the ability to move or lift at least fifty pounds. Able to remain focused and organized Able to exhibit manual dexterity and strength sufficient to perform medical examinations and procedures Qualifications:&nbsp;Qualifications: Graduate of an approved and accredited program for Nurse Midwifery Certification as a Nurse-midwife from the American College of Nurse-Midwives Current Certified Nurse Midwife license (or eligible for) in State of Utah Controlled substance licensure (or eligible for) in the State of Utah Eligibility for DEA registration Hours:&nbsp;Hours: To be determined

Revere Health

Certified Nurse Midwife-FT-OBGYN-Pleasant Grove

Qualifications: NJ School Nurse Certificate OR NJ Substitute School Nurse Certificate (eligible with RN License) Experience with secondary level preferred&nbsp; Assists in planning and implementing a health services program based on the health needs of students Interpret health needs to students, parents/guardians and school personnel Maintains health records consistent with state and local requirements Excellent communication and organizational skills&nbsp; *In accordance with S-414/A-3188 (<a href="http://www.njleg.state.nj.us/2018/Bills/S0500/414_R2.HTM" target="_blank">http://www.njleg.state.nj.us/2018/Bills/S0500/414_R2.HTM</a>), school districts, charter schools, nonpublic schools, and contracted service providers (“employers”) are required to review the last twenty years of employment history of prospective employees to ascertain allegations of child abuse or sexual misconduct. It explicitly prohibits such employers from hiring a person serving in a position which involves regular contact with students unless the employer conducts a review of the employment history of the applicant by contacting former and current employers and requesting information regarding child abuse and sexual misconduct allegations.

Cherry Hill Township Board of Education

Substitute School Nurse

DescriptionAt. St. Francis-Emory Healthcare, we recognize that our patients deserve qualified, engaged, and competent nurses. And we know that our nurses deserve a working environment that is safe, leaders who are visible and supportive, and opportunities to grow and develop. We have a positive, hopeful, and resilient leadership team that is solely focused on taking care of the heart of St. Francis – the people who work here. If you feel that your skills and compassion fit with our vision for person-centered care and evidence-based practice, and you would like to belong to a hospital family that only the best are invited to join, we invite you to apply today.&nbsp; Under the direction of the Clinical Coordinator and/or Nursing Unit Director: <ul><li>Perform nursing patient care duties for the assigned unit or department. </li><li>Plan, provide, and evaluate total nursing care in accordance with the established patient care philosophy. </li><li>Facilitate individualized, goal-directed nursing care through use of the nursing process and the principles of primary nursing in accordance with departmental and hospital policies and procedures. </li><li>Relate effectively with other shifts for continuity of care, maintain satisfactory relations with other departments and nursing units; and participate in all phases of education.</li></ul>WORK CONDITIONS/HOURS<ul><li>Normal hours are 8 a.m. – 5 p.m., Monday-Friday. However, schedules may vary in accordance with business necessity. Normal office working conditions.</li></ul>LifePoint considers a consistently positive, cooperative, self-motivated, courteous and professional attitude to be an essential function of every position. While different positions have different primary areas of responsibility, everyone needs to work as a team, and we expect all employees to roll up their sleeves and pitch in as necessary to get the job done.Employees must be able to relate to other people beyond giving and receiving instructions: <ul><li>(a) can get along with co-workers or peers without exhibiting behavioral extremes, </li><li>(b) perform work activities requiring negotiating, instructing, supervising, persuading, or speaking with others; </li><li>(c) respond appropriately to constructive feedback from a supervisor.</li></ul>While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances (e.g., emergencies, changes in workload, rush jobs or technological developments) dictate.FLSA: Non-exemptEEO:&nbsp;<ul><li>&nbsp;01 Officials and Managers </li><li>02 Professionals </li><li>03 Technicians&nbsp;</li><li>04 Sales Workers </li><li>05 Administrative Support Workers </li><li>06 Craft Workers </li><li>07 Operatives&nbsp;</li><li>08 Laborers and Helpers&nbsp;</li><li>09 Service Workers</li></ul> QualificationsMinimum Education<ul><li>Associates of science/nursing (Required) </li></ul>Certifications: <ul><li>X Basic Life Support (BLS) </li></ul>Licenses: <ul><li>Valid licensure in the State of Georgia as a Registered Nurse (RN) or multi state/compact RN license</li></ul>Minimum Work Experience <ul><li>Six (6) months of experience as a Registered Nurse (RN) in a direct patient care setting unless entering into the Nurse Residency Program</li></ul>Required Skills <ul><li>Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must beable to work in a stressful environment and take appropriate action.</li></ul>

St. Francis-Emory Healthcare

Registered Nurse-Med/Surg-FT days-

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>

U.S. Renal Care

Dialysis Registered Charge Nurse-Experienced Dialysis Charge Nurse Only

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.</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

Essential Duties and Responsibilities include the following. Other duties and tasks may be assigned.<ul><li>Demonstrate effective use of supplies and staff labor hours.</li><li> May assist with billing log preparation and updates.</li><li>Perform duties as assigned to meet the patient care or operational needs of the clinic</li><li> Obtain blood samples for laboratory analysis as required to complete physician orders.</li><li> Complete and document monthly review of patient medication profiles.</li><li>Knowledge of and comply with applicable health care professionals practice act requirements.</li><li>Perform duties at all times under the supervision of a Charge Nurse and within limitations established by and in accordance with company policy and procedures, applicable state and federal laws and regulations</li><li>Maintain thorough, accurate, and appropriate documentation in the patient record of all treatments, activities, and communication with the patient, physician and other healthcare professionals to include progress reports.</li><li>Report any significant information or change in patient condition to the Charge Nurse.</li><li> Report machine problems to Biomedical Technician and Administrator.</li><li> Participate in staff meetings as required. Attend in-service and continuing education offerings in compliance with company policy and procedure.</li><li>Assist with staff training as requested.</li></ul>

Dialysis Licensed Vocational Nurse- Dialysis Experience

Dialysis Registered Charge Nurse

JOB SUMMARY This position requires the employee to facilitate and maintain the development of strong and engaged bargaining units. &nbsp;The employee is part of the Oregon Nurses Association (ONA) labor department, which empowers healthcare workers to advocate for themselves, their patients, their families, and their communities.COMPENSATION AND BENEFITS: This is a full time, exempt position. The salary is based on applicable years of experience applied to the wage scale outlined in the union staff ’s collective bargaining agreement.Effective July 1, 2024 ONA offers an annual starting salary range for this position of $77,998.71 to $112,495.81 depending on experience.ONA also offers an exceptional benefits package including employer contributions (90%) to medical, dental and vision premiums, as well as employer paid long and short-term disability and life insurance. Opportunity to enroll in 401K plan after 6 months of employment which includes a 3% employer contribution, with additional longevity contributions after 5 years. Union members are also enrolled in a union pension plan. &nbsp;Annual PTO is 25 vacation days, 8 personal days and 12 sick leave days.OUR COMMITMENT TO EQUITY AND FAIRNESS ONA is deeply committed to diversity and inclusion in its hiring practices. We are an affirmative action, equal opportunity employer. Our employment decisions are made without regard to race, color, religion, gender, gender identity, national origin, age, disability, marital status, veteran or military status, or any other legally protected status. Women and people of color are encouraged to apply.TO APPLY: For more information and/or to apply for this position, please click here (applications which do not include a resume will not be considered):&nbsp; <a href="https://secure.entertimeonline.com/ta/ONAG18.careers?ShowJob=436594455" target="_blank">https://secure.entertimeonline.com/ta/ONAG18.careers?ShowJob=436594455</a>&nbsp;

Oregon Nurses Association

Internal Labor Representative (Eugene)

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 Librus APRN is a key clinical leader in the delivery of person-centered, value-based care to Institutional Special Needs Plans (ISNP), ACOs, and high-risk payors residing in Skilled Nursing Facilities, communities, or private homes. Working in alignment with the payor's model of care and under the Librus program, the APRN performs comprehensive clinical assessments, closes care gaps, participates in IDT meetings, ensures accurate HCC coding, reduces unneeded hospitalizations, and delivers high-quality primary and supportive care to medically complex patients. This role also includes providing end-of-life services, including comfort and symptom-focused care without formal hospice enrollment, ensuring quality of life and dignity are prioritized during serious illness and advanced aging.Qualifications: Required:<ul><li>Licensed APRN with active certification (Adult/Geriatric NP, FNP, or similar) in the state of Florida.</li><li>DEA license with prescriptive authority.</li><li>Minimum 3 years of experience as a nurse practitioner, preferably in geriatrics, SNF, hospice, palliative care, or complex care management.</li><li>Demonstrated experience with HCC coding and risk adjustment models.</li><li>Familiarity with Medicare Advantage care gap closure metrics.</li></ul>Preferred:<ul><li>Experience with ISNPs, D-SNPs, or other value-based Medicare models.</li><li>Knowledge of SNF workflows and interdisciplinary care teams.</li><li>Comfort and skill in end-of-life conversations and palliative approaches.</li></ul>Schedule &amp; Travel:<ul><li>Full-time, Monday–Friday with flexibility for urgent needs</li><li>On-site presence in designated SNFs with occasional local travel</li><li>Minimal on-call rotation, shared with other advanced practice providers</li></ul>Competencies:<ul><li>Advanced clinical assessment and diagnostic skills</li><li>Coding and documentation proficiency (HCC, SOAP, risk adjustment)</li><li>Compassionate care mindset with emotional intelligence</li><li>Collaborative leadership across multiple teams</li><li>Strategic time and case management abilities</li></ul>Responsibilities of all employees:<ul><li>Represent the Company professionally at all times through care delivered and/or services provided to all clients.</li><li>Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse.</li><li>Comply with Company policies, procedures and standard practices.</li><li>Observe the Company's health, safety and security practices.</li><li>Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company.</li><li>Use resources in a fiscally responsible manner.</li><li>Promote the Company through participation in community and professional organizations.</li><li>Participate proactively in improving performance at the organizational, departmental and individual levels.</li><li>Improve own professional knowledge and skill level.</li><li>Advance electronic media skills.</li><li>Support Company research and educational activities.</li><li>Share expertise with co-workers both formally and informally.</li><li>Participate in Quality Assessment and Performance Improvement activities as appropriate for the position.</li></ul>Job Responsibilities: Clinical Care Delivery:<ul><li>Serve as the primary advanced practice provider for assigned ISNP members, High-Needs ACO patients, and similar settings, delivering direct, evidence-based care in collaboration with facility and plan/payor staff.</li><li>Perform routine and urgent clinical assessments, diagnose and manage chronic and acute conditions, and adjust care plans.</li><li>Provide palliative and hospice-like care interventions focused on comfort, dignity, and patient-centered goals.</li></ul>HCC Coding &amp; Gap Closure:<ul><li>Conduct comprehensive annual and episodic assessments to ensure accurate capture of chronic conditions per CMS HCC guidelines.</li><li>Close quality gaps related to screenings, labs, immunizations, and chronic disease management per ISNP, Payor and plan metrics.</li><li>Maintain thorough, compliant documentation to support both care delivery and risk adjustment requirements.</li></ul>Model of Care Alignment:<ul><li>Operate as a clinical champion of the Librus Model of Care, emphasizing proactive interventions, interdisciplinary collaboration, and reduced avoidable hospitalizations.</li><li>Partner with the RN Care Coordinator and facility teams to ensure service continuity, integration, and alignment.</li></ul>Advanced Illness Management:<ul><li>Lead or participate in goals-of-care discussions, advance directive review, and shared decision-making with patients and families.</li><li>Support members through end-of-life transitions with empathy and skill, even without formal hospice enrollment.</li><li>Utilize comfort-focused prescribing and symptom management protocols.</li></ul>Collaboration &amp; Reporting:<ul><li>Attend IDT meetings and collaborate regularly with payor physicians, SNF staff, and Librus leadership.</li><li>Communicate care plans effectively with patients, caregivers, and staff.</li><li>Submit timely and accurate clinical documentation, coding, and quality reporting.</li></ul>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.

Chapters Health System

Nurse Practitioner CareNu

Salary Range:&nbsp;&nbsp;$117,509.00&nbsp;(Min.) -&nbsp;$152,762.00&nbsp;(Mid.) -&nbsp;$188,015.00&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 Manager, Appeals &amp; Grievances (A&amp;G) &amp; General Operations (Clinical) is responsible for the daily oversight of clinical appeals and grievances functions within the Appeals &amp; Grievances Department to ensure clinical grievances, complaints, appeals and complex issues are investigated and resolved using regulatory guidance across all lines of business. Provides direct supervision to the A&amp;G clinical team and the unit that supports them in order to assure operational effectiveness which includes the implementation and adherence to L.A. Care's Policies &amp; Procedures that meet Centers for Medicare and Medicaid Services (CMS), the California Department of Health Care Services (DHCS), the California Department of Managed Health Care (DMHC), the Managed Risk Medical Insurance Board (MRMIB), National Committee for Quality Assurance (NCQA) and other rules/ regulations/ standards. The Manager is responsible for establishing and monitoring processes to oversee and coordinate the identification, documentation, reporting, investigation and resolution of all member appeals and grievances in a timely and culturally-appropriate manner. Coordinates, tracks, and resolves internal and external appeal and grievance complaints for L.A. Care Plan Partners, including identifying opportunities for improvement.This position will be a role model for integrity and will establish and maintain effective professional work relationships, working collaboratively with all levels of management and business owners to help guide the discipline of planning, organizing, securing, managing, leading, and controlling resources to achieve specific goals.Manages all aspects of running an efficient &nbsp;team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.&nbsp;<h4>Duties</h4>Manage and oversee the handling of clinical grievances and appeals, for L.A. Care and Plan Partner members. Establishes and oversees processes and all relevant member correspondence for accuracy, clarity, and cultural appropriateness and sensitivity. Review and monitor procedures for identifying quality of care issues and work collaboratively with cross-functional departments to appropriately address and resolve member grievances. Serve as the Key Contact for State Fair Hearings, internal and external audits, DMHC and DHCS inquiries. Review and monitor procedures for identifying quality of care issues and work collaboratively with cross-functional departments to appropriately address and resolve member and provider grievances.Responsible for timely daily operations in the A&amp;G Clinical Services Unit and other general operations units. &nbsp;Ensures timely appeal and grievance reporting to regulatory agencies, internal Regulatory Affairs and Compliance Department, internal Quality Oversight Committee, etc. Collaborates with cross-functional departments &nbsp;to ensure the use of appropriate appeal and grievance issue codes, timely resolution, and refers to community partners as appropriate. &nbsp;Lead, participate and provide representation of the A&amp;G Team at Internal and External meetings/ workgroups and acts as the point person for A&amp;G Programs especially the Clinical Programs.Develop and execute on strategic opportunities to improve the overall appeals &amp; grievance process. Create a best in clinical appeals process that is efficient and effective in managing member appeals.Work cross functionally and collaboratively within Appeals and Grievances with key internal partners to build a high functioning, results oriented environment and organization.&nbsp;<h4>Duties Continued</h4>Partner with internal and external stakeholders to build and maintain collaborative relationships and partnerships. Identify areas of connection to leverage and create added value for L.A. Care.Provide input into the development of automation to guide the team to process efficiencies for all lines of business while maintaining compliance and manageable workloads for staff.Responsible for maintaining and updating on an annual basis, or as necessary, appeal and grievance policies and procedures, member correspondence, etc., consistent with regulatory changes. &nbsp;Develop and maintain inventory reports for the appeals process ensuring appropriate productivity, compliance, and inventory management. &nbsp;Identify and implement continuous business process improvement recommendations to leverage organizational added value to the Appeals and Grievances Department. &nbsp;Develop and implement short and long-term strategies to improve team results, reducing administrative expenses.Manage staff , including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others. Supervision of the Clinical Services unit and general operations within Appeals and Grievances. Maintain a team of top talent, providing a culture of teamwork and collaboration.&nbsp;Perform other duties as assigned<h4>Education Required</h4>Bachelor's Degree in Nursing<h4>Education Preferred</h4><h4>Experience</h4>Required:6 years of clinical acute care experience with at least 3 years of experience with health care grievance and/or appeals issues, preferably in a managed care or Medicaid Health Plan environment and/or public services or public benefits programs.At least 3 years of management level operations leadership experience.Experience working with firm deadlines, regulators, detail oriented with the ability to interpret and apply regulationsExperience building relationships with organizations and business partners.Equivalency:&nbsp; Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.Preferred:&nbsp; Managed care experience.<h4>Skills</h4>Required: Excellent analytical, problem solving, planning and implementation skills.Demonstrated strong writing and communication skills.Demonstrates excellent leadership, communication, and negotiation skills with the ability to interact and influence all levels of the organization including executive management and key decision -makers.Demonstrates professional judgement, and critical thinking, to promote the delivery of quality, cost-effective care.Time management and priority setting skills.Excellent understanding of NCQA, DMHC, DOI, DHCS, and CMS regulatory requirements.Knowledge of Coordination of Care, Medicare and Medi-Cal regulations, prior authorization, level of care and length of stay criteria sets.Able to work effectively with various internal departments/service areas, L.A. Care's plan partners, participating provider groups, and other external agencies.Able to operate PC-based software programs including proficiency in Word, Excel and PowerPoint presentations.Excellent verbal, written communication and presentation skills.<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>This position requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical situations and work on-call.This position requires handling various caseloads and flexibility to adapt to changing priorities which may include but not limited to redistributed work assignments, team projects, and other priorities as assignedSalary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.L.A. Care offers&nbsp;a wide range of benefits including<ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul> Nearest Major Market: Los Angeles Job Segment: Nursing, Registered Nurse, Nurse Management, Medicaid, Medicare, Healthcare

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