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 Managed Long-Term Services and Supports (MLTSS) Nurse Specialist RN II applies advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare and social services for L.A. Care members. Utilizes assessments, member-centered care planning, direct provider coordination/collaboration and psychosocial wraparound services to promote effective utilization of available Health Plan benefits including, but not limited to Community Based Adult Services (CBAS), Skilled Nursing Facility (SNF) services, Intermediate Care Facility for Developmentally Disabled (ICF/DD) services, CalAIM Community Supports, Palliative and Hospice Care. Scope of work includes care coordination functions and must adhere to regulatory mandates that apply to Utilization Management (UM) and Care Management (CM). This position is responsible for assessing, planning, coordinating, and monitoring care needs to ensure members receive high-quality, cost-effective care that promotes independence and quality of life. The MLTSS Nurse Specialist RN II conducts comprehensive health assessments and is a member of an interdisciplinary team that is key in identifying the physical, psychological and social needs of the member. The MLTSS Nurse Specialist RN II collaborates with Skilled Nursing Facilities (SNF), Intermediate Care Facility - Developmentally Disabled (ICF-DD), Community Based Adult Services (CBAS) Centers, Residential Care Facilities for the Elderly (RCFE), Preferred Provider Groups (PPG), CalAIM providers (i.e. Community Supports Vendors), Palliative and Hospice Care Providers and cross functional units to facilitate coordination of services. This position may require provider onsite visits as needed. Duties Responsible for performing assessments and clinical review of medical records to determine appropriate care including physical health, behavioral health, and social determinants of health needs for members referred to; MLTSS administered programs. Responsible for UM authorization functions for services requiring prior authorizations in a timely manner with adherence to regulatory requirements. Identify and address gaps in care or overutilization, including overlapping services. Engages with members by conducting telephonic nursing follow up and care coordination when necessary, including transitions of care for Long Term Care (LTC) and ICF/DD populations. Provides direction to non-clinicians who assist members with accessing services and arranges for all services required while coordinating with the health care team to eliminate duplication of services. Interfaces with Medical Directors, social workers, and interdisciplinary care team (ICT). Participates in ICT meetings and makes recommendations for MLTSS and other programs. Establishes relationships with referral sources and community resources, such as external providers and care coordinators, while maintaining strict member confidentiality and complying with all Health Insurance Portability and Accountability Act (HIPAA) requirements. Performs oversight and monitoring of provider performance for adherence to regulatory standards and contractual agreements. Participate in provider audits and quality improvement initiatives. Partners with Provider Network Management (PNM) and participates in Joint Operations Meetings (JOM). Duties Continued Facilitates care coordination with and provides education on available services to internal and external entities to improve member's short- and long-term goals in collaboration with member, caregivers, family, support systems, and physicians. A person-centered approach minimizes member confusion, and ensures the best care is delivered in the most appropriate setting. Documents accurately and comprehensively based on the standards of practice and current organization policies. Performs other CM and UM functions as assigned and as needed /required by L.A. Care, to maintain regulatory requirements and company objectives. Performs other duties as assigned. Education Required Associate's Degree in NursingEducation Preferred Bachelor's Degree in NursingExperience Required: At least 3 years of clinical nursing experience in direct patient care, such as ambulatory care, home care, palliative care, hospice care OR experience in Utilization Review or Care Management will be considered in lieu of direct patient care that may include at least 2 years of relevant Licensed Vocational Nurse (LVN) experience in a UM or CM capacity substituted for 1 year of RN experience. Clinical experience working with individuals with chronic illnesses, comorbidities, and/or disabilities in a UM/CM environment. Preferred: Experience in utilization review, skilled nursing, home health, discharge planning, behavioral health, community resources, and/or other home and community-based agencies. Skills Required: Excellent verbal and written communication skills; with effective charting practices. Excellent organizational, time-management and priority-setting skills. Strong clinical skills with a knowledge of care needs for elderly, disabled, and/or frail populations and has applied knowledge of End-of-Life care. Customer Service Skills: Provision of excellent customer service required due to frequent communication with providers, members and interdisciplinary team. Technical Skills: Must be computer literate and proficient in Microsoft Office (Outlook, Word, Excel, PowerPoint, Teams). Ability to effectively utilize computer and appropriate software and interacts as needed with L.A. Care Information System. Ability to maintain strict member confidentiality and complies with all HIPAA requirements. Preferred: Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese. Licenses/Certifications Required Registered Nurse (RN) - Active, current and unrestricted California LicenseLicenses/Certifications Preferred Certified Case Manager (CCM)Required Training Physical Requirements LightAdditional Information Required: Travel to offsite locations for work. 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) $160,000 - $175,000 / year
West Covina Healthcare Center is a 99-bed skilled nursing facility. Must have SNF experience POSITION SUMMARY The purpose of your job position is to manage, develop, and direct the overall operation of the nursing department in accordance with current federal, state, and local standards that govern the facility, and as directed by the Administrator and Medical Director. The Director of Nursing will treat each resident with kindness, dignity and respect. They will knock before entering each resident’s room. They will refer to each resident by their name. They will be courteous to families, visitors and all staff. They will maintain a positive and calm disposition. They will communicate clearly, diplomatically, and effectively when speaking to residents, family members, visitors, staff and any governmental agency personnel. They will make sound independent decisions. They will set an example of working collaboratively between multidisciplinary teams. They will demonstrate patience, initiative and willingness to assist residents that may be difficult. They will be committed to always doing the right thing. ESSENTIAL DUTIES AND RESPONSIBILITIES Coordinating with the Administrator to recruit and select nursing staff Reviewing scheduling and staffing to ensure daily PPD requirements are met Working with DSD in monitoring the in-service trainings Providing assistance to nursing staff when needed (including admissions, med pass and wound care) Making written and verbal recommendations to the Administrator as needed concerning the operations of the nursing department Maintaining and updating the policies and procedures that govern the daily functions of the nursing department Developing and conducting performance evaluations for annual reviews of nursing staff Reviewing residents discharge plans Making rounds Assisting in surveys (inspections); and following up with corrective measures Monitoring the facility’s QI and survey reports Reviewing complaints and grievances made or filed by staff, residents or third parties Reporting occupational exposures to blood, body fluids, infectious materials, and hazardous chemicals as required by state and federal law Abiding with all facility policies and procedures including not disclosing user ID codes and passwords Keeping abreast of new state and federal regulations as they pertain to skilled nursing Attending meetings and serving on committees Complying with annual facility in-service training programs Every effort has been made to identify the essential functions of this position. However, it in no way states or implies these are the only duties you will be required to perform as directed by management. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or is an essential function of the position. REQUIREMENTS Education / Licensure Nursing Degree from accredited school or college Valid RN license in good standing Valid CPR and BLS card Qualifications / Experience Minimum of 1 year as director of nursing/supervisor for a skilled nursing facility Must be able to speak, read, write and comprehend the English language Proficiency with PCC a plus Working Conditions May encounter frequent interruptions May be involved with residents, family and government agencies May be requested to work beyond scheduled working hours at times Is subject to call-back during emergency conditions (e.g., severe weather, evacuation, post-disaster, etc.) May be subjected to odors, dust, disinfectants, tobacco smoking or air contaminants May be exposed to infectious waste, diseases, conditions, etc., including TB and the AIDS and Hepatitis B viruses May be exposed to or handle hazardous chemicals Physical Requirements Must be able to move intermittently throughout the day Working throughout the nursing areas Must be able to lift up to 25 pounds, lifting more weight up to 100 pounds requires assistance Ability to read fine print on tablet, progress notes and/or medical labels 
