Latest Nursing and Nursing Support Jobs
$88,854 - $142,166 / year
Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (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. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves medically necessary referrals that meet established criteria. Assures timely and accurate determination and notification of referrals and reconsiderations based on the referral determination status. Generates approval, modification and denial communications, to include member and provider notification of referral determination. Actively monitors for admissions in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review, and collaborates with onsite staff, physicians, providers, member/family interaction to develop and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service, concurrent, post-service and retrospective claims medical review. Monitors and oversees the collection and transfer of data (medical records) and referral requests by Providers. Acts as a department resource for medical service requests /referral management and processes. Receives incoming calls from providers, professionally handles complex calls, researches to identify timely and accurate resolution steps. Follows up with caller to provide response or resolution steps. Answers all inquiries in a professional and courteous manner. Duties Promote and support team engagements, programs and activities to create and ensure a positive and productive workplace environment. Perform telephonic and/or onsite admission and concurrent review, and collaborates with onsite staff, physicians, providers, the member and significant others to develop and implement a successful discharge plan. Process, finalize and facilitate inbound requests that are received from providers. Generate appropriate member and provider communication for all determinations within the required timelines as defined by the most current department policy. Facilitate/review requests for Higher level of care or skilled nursing/discharge planning needs. Research for appropriate facilities, specialty providers and ancillary providers to utilize for all lines of business. Identification of potential areas of improvement within the provider network. Identify and initiate referrals for appropriate members to the various L.A. Care programs/processes and external community based programs or Linked and Carve Out Services (e.g. DDS/CCS/MH). Potential quality of care/potential fraud issues are identified and documented per L.A. Care policy. High risk/high cost cases and reports are maintained and referred to the Physician Advisor/UM Director. Document in platform/system of record. Utilize designated software system to document reviews and/or notes. Receive incoming calls from providers, professionally handle complex calls, research to identify timely and accurate resolution steps. Follow up with caller to provide response or resolution steps. Answer all inquiries in a professional and courteous manner. Perform other duties as assigned. Duties Continued Education Required Associate's Degree in NursingEducation Preferred Bachelor's Degree in NursingExperience Required: At least 5 years of varied RN clinical experience in an acute hospital setting. At least 2 years of Utilization Management/Case Management experience in a hospital or HMO setting . Preferred: Managed Care experience performing UM and CM at a medical group or management services organization. Experience with Managed Medi-Cal, Medicare, and commercial lines of business. Skills Required: Must be computer literate, with expertise in Outlook, Word, Excel, PowerPoint. Effectively utilizes computer and appropriate software and interacts as needed with L.A. Care Information System. Knowledge of personal computer, keyboarding, and appropriate software to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Prepare clear, comprehensive written and oral reports and materials. Provision of excellent customer service required due to frequent communication with providers and other members of the interdisciplinary team Excellent time management and priority-setting skills. Maintains strict member confidentiality and complies with all HIPAA requirements. Strong verbal and written communication skills. Preferred: Knowledge of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or Care Management (CM). Knowledge of Department of Health Care Services (DHCS) or Centers for Medicare and Medicaid Services(CMS) requirements for health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse (RN) - Active, current and unrestricted California LicenseLicenses/Certifications Preferred Certified Case Manager (CCM)Required Training Physical Requirements LightAdditional Information May work on occasional weekends and some holidays depending on business needs. Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including Paid Time Off (PTO) Tuition Reimbursement Retirement Plans Medical, Dental and Vision Wellness Program Volunteer Time Off (VTO) 
Main Function: Under the supervision of the Clinical Nurse Manager, performs duties in the care and treatment of patients on maintenance dialysis. We are seeking a Registered Nurse who has at least 1 year of experience, caring for patients Mon-Wed-Fri. 5am till 6:30 pm, Candidate must be licensed in New York and have current BCLS certification. Candidate should have knowledge with computers and electronic charting. We offer very competitive compensation and comprehensive benefits. Join us and be part of a dynamic and professional team in a state of the art facility. $118,000 - $125,000 / year
Overview About us: Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn. Brief summary or purpose: The RN Assessment Supervisor is responsible for: Lead a multi‑site RN team to ensure timely, high‑quality assessments and care coordination. Ensure all assessments are completed accurately, efficiently, and on schedule. Provide coaching, supervision, and training; implement remediation when needed. Work with navigators and care teams to support comprehensive member care. Partner with Clinical Integration Leaders to implement required Models of Care and program standards. Monitor team performance, ensure compliance, and maintain staff readiness. Support quality improvement efforts tied to NCQA, HEDIS, CMS, State, and other performance measures. Prepare and organize case files for audits and regulatory reviews. Build collaborative relationships with State agencies and community providers to support coordinated services. Responsibilities Primary Job Responsibilities: Primary Goals Ensure timely, accurate assessments for members. Maintain high team performance, productivity, and compliance. Support quality, regulatory, and program standards. Strengthen collaboration across internal teams and community partners. Key Tasks Team Leadership & Oversight Lead a multi-site RN team and ensure assessments are completed correctly and on schedule. Hire, train, coach, and evaluate staff; address performance issues when needed. Monitor workloads, reassign tasks, and ensure team readiness. Hold regular 1:1s, huddles, and case discussions. Audit documentation for accuracy and adherence to workflows. Assessment & Program Management Ensure proper use of all assessment tools (MDS HC, UAT, product-specific tools). Serve as subject matter expert for MDS submissions and PCA time-for-task guidelines. Ensure accurate member rating category assignments. Guide staff in whole-person care planning (medical, behavioral, social). Quality & Compliance Support quality initiatives (NCQA, HEDIS, CMS Stars, State measures). Use reporting tools to track performance; teach staff to use reports independently. Prepare assessment cases and documentation for audits and regulatory reviews. Ensure strict HIPAA compliance. Collaboration & External Relationships Work closely with navigators, care managers, and integration leaders. Support Models of Care and program requirements across product lines. Maintain partnerships with state agencies and community providers. Share information on clinical, social, and financial resources. Additional Responsibilities Provide support and coverage within the department as needed. Complete other tasks assigned by the Manager/Director. Qualifications Qualification Requirements Education Graduate from an accredited school of nursing, associates degree required, bachelor’s or higher strongly preferred License/Certifications License: RN Candidates (Required) Active, unrestricted license as a Registered Nurse in Massachusetts Certification : Certification in Case Management strongly desired, willingness to obtain when eligible Other: Driving your personal motor vehicle is an essential job function of this position and the following requirements apply: Must possess a valid drivers’ license Must attest to no disqualifiers per Driver Safety Policy Must possess and provide proof of minimal state required auto insurance Must have reliable transportation Experience 4+ years RN clinical experience managing patients with complex medical, behavioral, and social needs. Strong customer service skills and ability to resolve issues quickly. Experience with process improvement and using data to enhance workflows (preferred). Excellent organization and multitasking abilities. Knowledge of community resources, levels of care, and developing care plans that meet regulatory standards. Able to adapt to changing needs, think creatively, and solve problems. Experience supervising staff supporting social determinants of health needs (preferred). Experience with OASIS and/or MDS assessments (preferred). Familiarity with Medicare and Medicaid programs and regulations (preferred). Background in social service agencies or related state agencies (DMH, DDS, DCF, DYS) or community service organizations (preferred). Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $118,000 - $125,000 annually, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities. Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. #P01 
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