Nursing Jobs in Baldwin Park, CA
$150,000 - $170,000 / year
Overview Director Clinical Operations Location: Glendale, CA Position: Hospice Director of Clinical Operations Registered Nurse Job ID: 2026-89868 Remote/Virtual Position: No Coverage Area: Los Angeles area Find Your Passion and Purpose as a Director of Clincial Operations Salary: $150k - $170k DOE Schedule: M-F / Limited On call support as needed Competitive Health Benefits Generous PTO, Matching 401k Mileage Reimbursement California RN License Required Compensation Based on Experience What You Need to Know Reimagine Your Career in Hospice Caring for others is more than what you do — it’s who you are. At AccentCare, you’ll join a purpose-driven, collaborative culture that sets the standard for excellence and gives you the trust and tools to do your best work. You’ll belong to a team that cares deeply for patients and each other; a team committed to consistently providing exceptional care. We’re proud to be named one of America’s Greatest Workplaces 2025 by Newsweek — a reflection of our shared commitment to excellence, integrity and compassion as we shape the future of aging in place. When you thrive, so does the community of care we’re building together. Be the Director of Clinical Operations You Can Be If you meet these qualifications, we would love to meet you: Bachelor’s degree or commensurate work experience accepted 5 years of home based care experience preferred Role may require travel up to 80% of business days in supported territory Comprehensive knowledge of theories, concepts and practices and ability to use in complex, difficult and/or unprecedented situations Licensed to practice as a registered nurse in the state of agency operation Must be a licensed driver who can travel to all business locations Responsibilities: As a Director of Clinical Operations, you will: Supervises all direct patient/family care team members, including nurses, Supportive Care, home health aides and counselors, in collaboration with Site Leadership. Responsible for oversight of and/or scheduling, payroll and other administrative duties Assures that all initial assessments and required reassessments are conducted by qualified team members within required time frames, including documentation completion, submission and /or synchronization. Ensures that all patient/family services comply with federal, state(s) and local regulatory requirements and with accepted professional standards. Ensures protocols are utilized to guide operations and promote adherence to regulatory and internal process requirements. Monitor expenses related to patient/family services to ensure budgetary compliance in collaboration with IDG and Site Leadership. Serve as a resource person and liaison for the Social Worker, Volunteer, Music Therapy and Bereavement Departments. Our benefits include: Medical, dental and vision coverage Paid time off and paid holidays Professional development opportunities Company-matching 401(k) Flexible spending and health savings accounts Wellness offerings such as an employee assistance program, pet insurance and access to Calm, a meditation, sleep and relaxation app Programs to celebrate achievements, milestones and fellow employees Company store credit for your first AccentCare-branded scrubs for patient-facing employees And more! Why AccentCare? Come As You Are At AccentCare, you’re part of a community that cares — for patients and each other. You can rest assured we offer equal employment opportunities regardless of race, ethnicity, sex, sexual orientation, gender identity, religion, national origin, age or disability. 
$102,183 - $163,492 / year
Salary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (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 Clinical Policy Clinical Coder RN II is responsible for analyzing, interpreting, and operationalizing medical and utilization management policies to ensure accurate coding, appropriate authorization requirements, compliant claims processing, and effective utilization oversight. This position serves as a key clinical and coding resource, translating medical policy requirements into diagnosis, procedure, and service code logic, including determining which codes require prior authorization. Conducts in-depth research and analysis of legislation and regulatory requirements, clinical outcomes, utilization, claims, and financial data to identify utilization trends, fiscal risk, and opportunities for policy enhancement and cost containment. This position works cross-functionally with internal teams to ensure policies are codified, consistently applied, and monitored through reporting and data analysis. This position collaborates closely with internal stakeholders and external entities to support standardized benefit administration, effective program implementation, and organizational compliance with state, federal, and accreditation requirements. Duties Translate approved clinical policies and utilization management criteria into clear, codified claims rules and system logic to support accurate claims adjudication. Develop, revise, and recommend clinical policies and internal utilization management criteria when standard clinical guidelines are insufficient to support appropriate decision-making based on codified claim rules. Assess the downstream claims impact of new or revised clinical policies prior to implementation and recommend configuration updates to mitigate operational or financial risk. Participate in validation of claims configuration changes to ensure policies are applied correctly and consistently across all lines of business. Monitor post-implementation claims activity to identify configuration issues, unintended denials, or payment discrepancies related to clinical policy application. Support remediation of claims configuration defects by identifying root causes and coordinating corrective actions with internal teams. Participate in and lead specialty and cross-functional workgroups and committees focused on healthcare services clinical policies, utilization management processes, strategic initiatives, policy governance, operational alignment, and continuous improvement efforts. Ensure timely dissemination of accurate and consistent policies and procedures across departments. Promote collaboration, engagement, and a positive work environment while supporting departmental initiatives and team-based activities. Manage assigned projects from concept through implementation, ensuring timelines, quality standards, and deliverables are met. Analyze and interpret medical and utilization management policies to identify applicable diagnosis, procedure, and service codes and determine authorization, pre-payment, or post-payment review requirements. Define and maintain code lists that require prior authorization or other utilization management controls based on clinical evidence, regulatory guidance, utilization trends, and financial risk.Duties Continued Collaborate with internal teams to ensure authorization requirements and coding logic are accurately configured in authorization and claims systems based on authorization matrix requirements. Support accurate claims processing by validating codified authorization and policy requirements are correctly applied and aligned with approved medical policies. Provide clinical and coding recommendations to support the development, revision, and implementation of new or updated medical and utilization management policies. Investigate and resolve coding and authorization related issues, including claim denials, coding edits, authorization discrepancies, and policy interpretation questions. Review and assess claims edits, authorization matrixes, and coding rules to identify root causes of errors or inconsistencies and recommend corrective actions. Ensure coding, authorization requirements, and claims-related guidance align with medical necessity criteria, benefit structures, and applicable state, federal, and regulatory requirements. Develop, review, and maintain reporting related to authorization required codes, approval and denial rates, utilization patterns, claims payment outcomes, and policy effectiveness. Prepare reports, summaries, and presentations and communicate findings, recommendations, and action plans to internal and external stakeholders. Analyze claims, authorization, and utilization data to identify trends, measure policy impact, and recommend opportunities for policy refinement, cost containment, or reduction of administrative burden. Monitor post-implementation performance of authorization-required codes and recommend additions, removals, or modifications to authorization requirements based on regulatory thresholds and utilization outcomes. Perform other duties as assigned.Education Required Associate's Degree in NursingEducation Preferred Bachelor's Degree in NursingExperience Required: At least 8 years of experience in Clinical Nursing. At least 3 years of experience with Medi-Cal and Medicare in a managed care environment. Experience in performing and creating clinical documentation. Experience in regulatory compliance for a health plan. Experience with medical coding systems. Preferred: At least 1 year of experience in editing and writing clinical health services policies within a managed care health plan. Skills Required: Proficient with clinical policy through skills in literature searching and clinical research analysis based on the best available evidence. Working knowledge of clinical policies. Working knowledge of CPT/HCPC codes and claims. Ability to translate regulatory requirements into auditable tools. Ability to perform independent research on complex medical topics. Excellent verbal and written communication skills. Strong analytical, problem solving, and team building skills. Ability to work independently with strong self-direction. Advanced proficiency in Microsoft Word, Excel, and PDF documentation tools. Ability to work effectively with diverse teams in cross-functional work groups. Ability to multitask, re-prioritize tasking, and streamline day-to-day operations. Ability to identify discrepancies, assess risk, and recommend actionable solutions. Knowledge of medical coding systems, including ICD-10-CM, CPT, and HCPCS, and their application in authorization and claims environments. Strong organizational and time-management skills. Preferred: Advanced skills in assessing clinical policy deficiencies through literature searching and clinical research analysis based on the best available evidence. Proficient in claims configuration, including claims adjudication workflows, configuration of claims edits and rules, and the translation of clinical and utilization management policies into system-based claims logic to support accurate, compliant payment outcomes. Understanding of the managed care industry and market conditions.Licenses/Certifications Required Registered Nurse (RN) - Active, current and unrestricted California LicenseLicenses/Certifications Preferred Certified Professional Coder (CPC)Required Training Physical Requirements LightAdditional Information 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) 
