Nursing Jobs in Azusa, CA
$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) 
Now Hiring: Caregiver Green Leaf Senior Living 8101 Painter Ave Whittier, CA 90602 Why work for us? Caring and compassionate environment Opportunity for growth, success and longevity Come join employees who have become family! Supportive Management team Benefits: Beautiful work environment Competitive Wages and Benefit Package Flexible Schedule Paid Time Off Overtime Pay Responsibilities of the Caregiver: You will be accountable for the administration of medications, accurate medication recordkeeping, and resident care. Assisting with personal care: bathing and grooming, dressing, toileting, and exercise. Promote the highest degree of quality care to our residents. Qualifications of Caregiver: High school diploma preferred. Caregiver experience preferred but not required. Description At UCLA Health, our love for our patients comes shining through during some of the most challenging times in their lives. Our nurses bring hope and healing to their patients through compassion, empathy, assurance, and the highest level of clinical expertise. If you have a passion for advancing nursing excellence, we invite you to join us. In this exciting and rewarding position, you will provide exceptional nursing care for our coronary critical care patients . You will offer guidance to team members by supervising nursing interventions and assigning related tasks. You will also assess patient, family and staff learning needs, deliver appropriate clinical education and promote effective working relationships. This involves collaborating with an interdisciplinary team of dedicated professionals to develop and implement a care plan, including providing detailed care instructions. Salary range: $65.76-$97.76/Hourly $94,000 - $118,000 / year
Description Kindred Hospital Rancho is a 55-bed long-term acute care hospital offering the same in-depth care you would receive in a traditional hospital, but for an extended recovery period. We partner with your physician and offer 24-hour clinical care seven days a week so you can start your journey to wellness. For those who need special care, we offer an eight-bed ICU and three negative pressure rooms. We are located near downtown Rancho Cucamonga just off of Foothill Boulevard with close proximity to many shops and restaurants. Job Summary Plans, coordinates and teaches continuing education and in-service education for the hospital, including General Orientation. Develops monthly education calendar. Conducts corporate compliance agreement training and other needed staff education. Participates in development of short-term and long-term educational goals based on identified needs through Quality Council and annual assessments. Collaborates with managers to evaluate staff competency. Essential Functions Participates in development of short-term and long-term educational goals based on identified needs through Quality Council, Annual Assessments, etc. Assists Department Directors with the development of specific orientation and staff competency programs. Forecasts and administers education operating budget. Plans and coordinates continuing and in-service education for the hospital. Develops, plans and coordinates general hospital orientation. Coordinates with various department heads to include their specialty area. Develops, plans and coordinates periodic in-service training on those issues identified by the Hospital Quality Council or a designated Performance Improvement Team. Ensures that the hospital's employees receive compliance training and all education necessary to perform their job responsibilities, as required by the Company's Code of Business Conduct and the Corporate Compliance Agreement. Develops, designs and provides for a written scope of services, departmental policies and procedures that guide and support the provision and integration of services according to mission and vision of the hospital. Knowledge/Skills/Abilities/Expectations Approximate percent of time required to travel: 0% Must read, write and speak fluent English. Must have good and regular attendance. Performs other related duties as assigned. Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software. Able to organize tasks, develop action plans, set priorities and function under stressful situations. Ability to maintain a good working relationship both within the department and with other departments. Knowledge of accreditation standards and compliance requirements. Ability to demonstrate critical thinking, appropriate prioritization and time management skills. Ability to work under stress and to respond quickly in emergency situations. Pay range: $94K - $118K/Yr ScionHealth has a comprehensive benefits package for benefit-eligible employees that includes Medical, Dental, Vision, 401(k), FSA/HSA, Life Insurance, Paid Time Off, and Wellness. Qualifications Education Bachelor’s degree in nursing required Masters preferred Licenses/Certifications Current state licensure as a Registered Nurse. BLS and ACLS certifications required Experience Five years of experience in an acute care Medical/Surgical and/or 
Now Hiring: MedTech Green Leaf Senior Living 8101 Painter Ave Whittier, CA 90602 Why work for us? Caring and compassionate environment Opportunity for growth, success and longevity Come join employees who have become family! Supportive Management team Benefits: Beautiful work environment Competitive Wages and Benefit Package Flexible Schedule Paid Time Off Overtime Pay 401(k) Now Hiring: MedTech Qualifications of MedTech : High school diploma preferred. MedTech experience in a facility preferred 
Now Hiring: MedTech Green Leaf Senior Living 8101 Painter Ave Whittier, CA 90602 Why work for us? Caring and compassionate environment Opportunity for growth, success and longevity Come join employees who have become family! Supportive Management team Benefits: Beautiful work environment Competitive Wages and Benefit Package Flexible Schedule Paid Time Off Overtime Pay 401(k) Now Hiring: MedTech Qualifications of MedTech : High school diploma preferred. MedTech experience in a facility preferred 
