Nursing Jobs in Bel Air, CA
$151,424 - $249,850 / year
The Nurse Practitioner (NP) has a specialized skill and knowledge related to the setting in which they practice and perform physical exams, collects and documents data, conducts approved diagnostic and therapeutic procedures, orders and schedules laboratory studies and professional consultations, prescribes appropriate interventions and medications, and provides direct patient care services, according to established evidence-based clinical practice standards. The NP contributes to excellence in patient care, research, teaching, consulting, and provides leadership to the organization and advance practice profession. Duties may include but not limited to obtaining patient health histories and complete physical examinations, documenting findings noting pertinent normal and abnormal findings, ordering and interpreting appropriate diagnostic and laboratory tests, and performing procedures as needed within specialty area. The NP also helps facilitate safe and efficient operational flow of the patient through their continuum of care. The NP will function as a part of inter-professional teams by communicating, planning, and implementing care directly with other healthcare professionals, including but not limited to physicians, pharmacists, office support staff, and other advance practice providers (APPs). Departmental Specific Summary The Nurse Practitioner takes a leading role in activities such as managing the clinical aspects of clinic, patient rounding and care, nursing performance improvement, job performance/competency evaluations, staffing, scheduling and working with the directors, employees, and preceptors in the orientation and training of new employees. Executes leadership in the following areas: Direct/Indirect Patient Care, Support of Systems, Research, Education, and Professional Leadership. Works in collaboration with other health care team members, consulting and referring as appropriate, but retains responsibility for ongoing clinical management of the patient. Must work with any and every physician in the Orthopaedic Clinic. Other duties as assigned. Essential Duties Conducts in-depth interviews with patients and/or family, constructs comprehensive medical histories, performs initial and periodic physical examinations and explores patient’s interpretation of health needs. Identifies and treats patients’ diseases. Manages treatment of hospitalized patients. Identifies patient’s educational needs and provides health related information to enhance patient’s and family’s understanding of medical condition and related treatments. Obtains informed consent for procedures that will be performed. Instructs and counsels patients and families regarding care, medical problems, psychological problems and use of prescribed devices, treatments and drugs. Directly performs or orders appropriate diagnostic studies and interprets finished results. Develops and implements long and short range treatment plans. Performs procedures as defined by approved credentialing privileges. Writes orders to increase, decrease or change medication, subject to checking and counter-signing by physician. Initiates consultations and monitors scheduling of patients for special tests. Identifies records pertinent progress of patients, updating and summarizing charts, changing orders when appropriate and notifying the responsible physician of changes in the patient’s condition. Instructs and counsels patients and families regarding preventive care, medical problems, psychological problems, and use of prescribed treatments and drugs. Serves as a resource for clinic support staff (RN, LVN, MA, and others). Acts as liaison with governmental agencies such as Center for Disease Control and National Institute of Health. Assists with medical research projects, following medical research protocols. Obtains Investigational Review Board approval for treatment protocols. Researches community resources for referral of patients. Refers patients to most appropriate resource based on patients’ medical needs and condition. Maintains compliance with established University and department policies and procedures, quality assurance, safety, environmental, infection control and complies with requirements of accreditation and regulatory agencies. Participates in in-service education programs and professional associations. Performs other duties as assigned. Required Qualifications: Req Master’s degree Graduate from an accredited school of Nursing (MSN). Req 5 years Clinical nursing experience. Req Other certifications and experience as required per specialty area Req Must have excellent communication skills, including the ability to speak, read and write English proficiently. Req Knowledge of medical procedures and conditions and ability to understand, follow and successfully perform duties. Preferred Qualifications: Pref 3 years Experience as NP in specialty area preferred Required Licenses/Certifications: Req Registered Nurse - RN (CA Board of Registered Nursing) Req Nurse Practitioner - NP (CA Board of Registered Nursing) Req Nurse Practitioner Furnisher (CA DCA) Current license to furnish medications in the State of California. Req DEA Certificate Drug Enforcement Agency (DEA) Certificate issued by the U.S. Department of Justice for Schedule II-V controlled substances. Req NP Board Certified Possession of National Board Certification in Nurse Practitioner area of specialty accredited by Accreditation Board of Specialty Nursing (ABSNC) or National Commission for Certifying Agencies (NCCA). ◦ If work in Hospital/Acute Care Setting must have Certification from the American Nurses Credentialing Center (ANCC) or American Association of Critical-Care Nurses (AACN) as an Acute Care Nurse Practitioner (ACNP) or Adult Gerontology Acute Care Nurse Practitioner (AGACNP) upon hire. ▪ (*Grandfathered from Acute Care Certification requirement if hired/transferred prior to 12/2015.) Req Basic Life Support (BLS) Healthcare Provider from American Heart Association Req Advanced Cardiovascular Life Support (ACLS) Healthcare Provider from American Heart Association - *ACLS as required by the NPs Job description for NPs in the Hospital/Acute Care Setting and Ambulatory Infusion Centers (*Required for Hospital/Acute & Infusion Center Clinic settings only) Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only) USC Care Medical Group serves as the sole physician entity reporting to the USC Health System, uniting faculty clinical practice under Keck Medicine of USC. This entity oversees clinical governance, physician and ambulatory services, and core enterprise functions including billing, contracting, and financial operations. The organization encompasses 17 clinical departments, with approximately 1,500 physicians and 2,000 staff delivering care across more than 80 locations from Kern County to Orange County and into Las Vegas. USC Care Medical Group is the engine for patient-centered growth—advancing quality, safety, access, and financial strength through integrated, system-level thinking that transcends silos and traditional models. By building bridges across the enterprise, embracing innovation, and leveraging technology, we deliver seamless, 5-Star access and service while expanding clinical reach and diversified models of care. Our work fuels a sustainable cycle of good health—organizationally, financially, and within the communities we serve—driving continued growth from within and beyond the system’s boundaries. The annual base salary range for this position is $151,424.00 - $249,850.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations. USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristic protected by law or USC policy. USC observes affirmative action obligations consistent with state and federal law. USC will consider for employment all qualified applicants with criminal records in a manner consistent with applicable laws and regulations, including the Los Angeles County Fair Chance Ordinance for employers and the Fair Chance Initiative for Hiring Ordinance, and with due consideration for patient and student safety. Please refer to the Background Screening Policy Appendix D for specific employment screen implications for the position for which you are applying. We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone at (213) 821-8100, or by email at uschr@usc.edu . Inquiries will be treated as confidential to the extent permitted by law. Notice of Non-discrimination Employment Equity Read USC’s Clery Act Annual Security Report USC is a smoke-free environment Digital Accessibility If you are a current USC employee, please apply to this USC job posting in Workday by copying and pasting this link into your browser: https://wd5.myworkday.com/usc/d/inst/1$9925/9925$149809.htmld $167,960 - $274,726 / year
The Pre-Op Nurse Practitioner –(NP) is a NP who works under the direction of the Department's Administrative and Medical Directors to facilitate safe and efficient operational flow of the cardiovascular patient population at Keck Medical Center. The NP is responsible for the application of the nursing process, supervision of clinical practice, education, leadership, and patient care management. The NP will function as a part of inter-professional teams by communicating, planning, and implementing care directly with other healthcare professionals, including but not limited to physicians, pharmacists, office support staff, and clinical nurse specialists and nurse practitioners. Outpatient duties will include providing Cardiac Clearance for established Cardiology patients for surgery, pre-transplant evaluation as well as independent evaluation of general cardiology patients. This position may provide support to Cardiovascular Medicine physicians in their respective clinics by using a team approach to efficiently evaluate and treat our outpatient Cardiovascular Medicine patient population. Meeting all medical center requirements, the Pre-Op NP will be responsible for appropriate documentation, clinic consults. The NP will be responsible for follow up, coordination of care, assisting in triaging phone calls, clinical questions, and pharmacy. The NP may also be involved in our telemedicine program. The nurse practitioner should demonstrate a knowledge of regulatory requirements in the delivery of patient care. Demonstrates critical thinking in providing care according to the standards of the profession. Resource for RNs, LVNs, and support staff. Works in collaboration with other health care team members, consulting and referring as appropriate, but retains responsibility for ongoing clinical management of the patient (e.g. post-implant VAD care, heart failure, etc.). Departmental Specific Summary The Nurse Practitioner – Cardiology under general supervision and in accordance with standardized procedures, incumbent performs physical examinations and treats common episodic and chronic health care problems, counsels patients and families, monitors patient progress, assists with medical research projects. Resource for RNs, LVNs, and support staff. Works in collaboration with other health care team members, consulting and referring as appropriate, but retains responsibility for ongoing clinical management of the patient (e.g. post-implant VAD care, heart failure, etc.). Essential Duties 1. Conducts in-depth interviews with patients and/or family, constructs comprehensive medical histories, performs initial and periodic physical examinations and explores patient’s interpretation of health needs. Identifies and treats patients’ diseases (e.g. post-implant VAD care, heart failure, etc.). Manages treatment of hospitalized patients using critical and strategic thinking, analytical and planning skills while demonstrating effective organizational and time management skills. 2. Identifies patient’s educational needs and provides health related information to enhance patient’s and family’s understanding of medical condition and related treatments. Obtains informed consent for procedures that will be performed Instructs and counsels patients and families regarding care, medical problems, psychological problems and use of prescribed devices, treatments and drugs. 3. Directly performs or orders appropriate diagnostic studies and interprets finished results. 4. Develops and implements long and short range treatment plans. 5. Performs procedures such as obtaining specimens, performing injections, immunizations, lumbar punctures, skin biopsies, suturing, wound care and management of conditions produced by trauma or infection. 6. Writes orders to increase, decrease or change medication, subject to checking and counter-signing by physician. 7. Initiates consultations and monitors scheduling of patients for special tests. 8. Identifies records pertinent progress of patients, updating and summarizing charts, changing orders when appropriate and notifying the responsible physician of changes in the patient’s condition. 9. Instructs and counsels patients and families regarding preventive care, medical problems, psychological problems, and use of prescribed treatments and drugs. 10. Acts as the lead in the clinics (e.g. being the resource for RN, LVN, and support staff) and acts as the liaison with governmental agencies such as Center for Disease Control and National Institute of Health. Assists with medical research projects, following medical research protocols. Obtains Investigational Review Board approval for treatment protocols. 11. Researches community resources for referral of patients. Refers patients to most appropriate resource based on patients’ medical needs and condition. 12. Maintains compliance with established University and department policies and procedures, quality assurance, safety, environmental, infection control and complies with requirements of accreditation and regulatory agencies. 13. Participates in in-service education programs and professional associations. 14. Performs other duties as assigned. Required Qualifications: Req Master's degree Nursing Degree in a related field Req 3 years Experience as a NP required Req 2 years Experience as NP in general cardiology, cardiothoracic or cardiac surgery experience required. Req Must have excellent communication skills, including the ability to speak, read and write English proficiently. Req Knowledge of medical procedures and conditions and ability to understand, follow and successfully perform duties, including whole blood collection, and apheresis procedures, in accordance with administrative and clinical policies, regulations and procedures. Required Licenses/Certifications: Req Registered Nurse - RN (CA DCA) Current & Valid California Registered Nursing license. Req Nurse Practitioner - NP (CA DCA) Current & Valid California Nurse Practitioner license. ACNP, AGACNP, FNP, ANP, or AGNP required. Req DEA Certificate Drug Enforcement Agency (DEA) Certificate issued by the U.S. Department of Justice for Schedule II-V controlled substances Req NP Board Certified Possession of National Board Certification in Nurse Practitioner area of specialty accredited by Accreditation Board of Specialty Nursing (ABSNC) or National Commission for Certifying Agencies (NCCA). Req Basic Life Support (BLS) Healthcare Provider from American Heart Association Req Advanced Cardiovascular Life Support (ACLS) Healthcare Provider from American Heart Association Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only) USC Care Medical Group serves as the sole physician entity reporting to the USC Health System, uniting faculty clinical practice under Keck Medicine of USC. This entity oversees clinical governance, physician and ambulatory services, and core enterprise functions including billing, contracting, and financial operations. The organization encompasses 17 clinical departments, with approximately 1,500 physicians and 2,000 staff delivering care across more than 80 locations from Kern County to Orange County and into Las Vegas. USC Care Medical Group is the engine for patient-centered growth—advancing quality, safety, access, and financial strength through integrated, system-level thinking that transcends silos and traditional models. By building bridges across the enterprise, embracing innovation, and leveraging technology, we deliver seamless, 5-Star access and service while expanding clinical reach and diversified models of care. Our work fuels a sustainable cycle of good health—organizationally, financially, and within the communities we serve—driving continued growth from within and beyond the system’s boundaries. The annual base salary range for this position is $167,960.00 - $274,726.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations. USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristic protected by law or USC policy. USC observes affirmative action obligations consistent with state and federal law. USC will consider for employment all qualified applicants with criminal records in a manner consistent with applicable laws and regulations, including the Los Angeles County Fair Chance Ordinance for employers and the Fair Chance Initiative for Hiring Ordinance, and with due consideration for patient and student safety. Please refer to the Background Screening Policy Appendix D for specific employment screen implications for the position for which you are applying. We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone at (213) 821-8100, or by email at uschr@usc.edu . Inquiries will be treated as confidential to the extent permitted by law. Notice of Non-discrimination Employment Equity Read USC’s Clery Act Annual Security Report USC is a smoke-free environment Digital Accessibility If you are a current USC employee, please apply to this USC job posting in Workday by copying and pasting this link into your browser: https://wd5.myworkday.com/usc/d/inst/1$9925/9925$149827.htmld $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) 
$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 Supervisor of Utilization Management (UM) RN is responsible for executing the day-to-day operations of the UM department, and monitoring the Care Management (CM) staff’s responsibilities and activities. This includes, but not limited to, ensuring proper staffing and coverage; monitoring and evaluating departmental operations to ensure optimal efficiency, productivity, and effectiveness; documenting and appropriately addressing excellence or deviations in work, departmental, and organizational expectations; and conducting intermittent and annual performance evaluations. This role assists in triaging identified issues/problems and forming resolution within the scope of work/licensure. The Supervisor is a subject matter expert (SME) in Care/Case/Utilization Management and supporting regulations, policies, protocols, and procedures. This position serves as a formal and informal instructor, and escalates issues/concerns to the appropriate person when outside of their scope. This position is responsible in assisting with and development and maintenance of a successful and cohesive unit, with high level of productivity and accuracy to achieve the department's overall performance metrics. The Supervisor ensures all functions of the UM department are operating in accordance with the organization's mission, values and strategic goals, which are focused on quality care delivery and continuous improvement; and are provided in a manner that is responsive and sensitive to the needs of L.A. Care's culturally diverse membership. The position supports the UM Manager/Director. This role also assists UM Educator/Manager/Director in identification of training needs including, but not limited to, collaborating in development of programs, training materials, competency checklist, and orientation checklists necessary to meet education and training needs of UM staff. The position supervises all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports. Duties Ensures adequate/appropriate distributions of workforce, assignments and time off requests. Participates in the hiring and termination process providing recommendations with appropriate supporting documentation. Monitors of staff's performance including productivity and compliance with regulatory requirements, compliance with policies. Identifies, communicates and coaches to improve staff performance. Develops tools, job aids, and workflows to optimize the process flow, performance and productivity of the UM team. Completes intermittent and annual staff evaluations. Serves as the primary resource for all business-related questions/issues raised by staff; escalates to appropriate leader/team when necessary. Recommends and implements process improvement measures to achieve department's performance measures outcomes and goals. Plans and oversees UM activities according to model of care, program description and policy and procedures to provide timely, quality care and services to members. Maintains all assigned reporting responsibilities, conducts regular audits to ensure compliance with community, industry and organizational standards including regulatory requirements. Serves as a super-user on electronic programs and systems used by the department. Assists in the development of programs, workflows, tools, training materials, orientation checklists, and competency checklist necessary to meet educational needs. Trains new staff, remediation of seasoned staff and cross training as needed in specified business lines. Serves as a leader and role model as well as technical and informational resource for staff and peers. Duties Continued Fosters a culture that encourages employee contribution to ensure that the department maintains an environment in which quality flourishes. Services as member/resource/liaison to the Interdisciplinary Care Team. Recommends resources to improve performance standards in terms of Utilization Management. Collaborates with peers and colleagues within the organization to address process improvements, member's needs, department and organizational enhancements and communicate development as appropriate. Participates on internal and external committees as delegated or assigned. Serves as a consultant to other departments or organizations as needed. Responsible for the daily workflow and leading the work of assigned staff. This role will mentor, coach, act as a resource and provide feedback on performance of assigned staff. Performs other duties as assigned. Education Required Associate's Degree in NursingEducation Preferred Bachelor's Degree in NursingExperience Required: Minimum of 7 years of acute/clinical care experience. Minimum of 2 years of experience in Case/Care/Utilization Management in an acute care or health plan setting. Minimum of 3 years leading process, program, or staff or supervisory experience. Equivalency: Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement. Skills Required: Knowledge of state, federal and regulatory requirements in Care/Case/Utilization Management. Strong verbal and written communication skills. Computer literacy with proficiency with Microsoft Word, Excel, etc. and ability to learn core departmental computer systems and software. Excellent organizational, time management, and interpersonal skills. Must be detailed-oriented, energetic, and an enthusiastic team player. Must be able to work independently. Licenses/Certifications Required Registered Nurse (RN) - Active, current and unrestricted California LicenseLicenses/Certifications Preferred 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) 
$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 Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing the day-to-day clinical operations of the A&G department, and monitoring the A&G RN staff responsibilities and activities. This includes, but is not limited to, ensuring proper staffing and coverage; monitoring and evaluating departmental operations to ensure optimal efficiency, productivity, and effectiveness; documenting and appropriately addressing excellence or deviations in work, departmental, and organizational expectations; and conducting intermittent and annual performance evaluations. This role assists in triaging identified issues/problems and forming resolutions within the scope of work/licensure. The Supervisor is a subject matter expert (SME) in Appeals & Grievances and supporting regulations, policies, protocols, and procedures. This position serves as a formal and informal instructor, and escalates issues/concerns to the appropriate person when outside of their scope. This position is responsible for assisting with and development and maintenance of a successful and cohesive unit, with a high level of productivity and accuracy to achieve the department's overall performance metrics. The Supervisor ensures all functions of the A&G department are operating in accordance with the organization's mission, values and strategic goals, which are focused on quality care delivery and continuous improvement; and are provided in a manner that is responsive and sensitive to the needs of L.A Care's culturally diverse membership. The position supports the A&G Clinical Manager. This role also assists the A&G Leadership in identification of training needs including, but not limited to, collaborating in development of programs, training materials, competency checklist, and orientation checklists necessary to meet education and training needs of A&G staff. The position supervises all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports. Duties Ensures adequate/appropriate distributions of workforce, assignments and time off requests. Participates in the hiring and termination process providing recommendations with appropriate supporting documentation. Monitors staff’s performance including productivity and compliance with regulatory requirements, compliance with policies. Identifies, communicates and coaches to improve staff performance. Develops tools, job aids, and workflows to optimize the process flow, performance and productivity of the A&G team. Completes intermittent and annual staff evaluations. Serves as the primary resource for all business-related questions/issues raised by staff; escalates to appropriate leader/team when necessary. Recommends and implements process improvement measures to achieve department's performance measures outcomes and goals. Plans and oversees A&G clinical activities according to model of care, program description and policy and procedures to provide timely, quality care and services to members. Duties Continued Maintains all assigned reporting responsibilities, conducts regular audits to ensure compliance with community, industry and organizational standards including regulatory requirements. Serves as a super-user on electronic programs and systems used by the department. Assists in the development of programs, workflows, tools, training materials, orientation checklists, and competency checklist necessary to meet educational needs. Trains new staff, remediation of seasoned staff and cross training as needed in specified business lines. Serves as a leader and role model as well as technical and informational resource for staff and peers. Fosters a culture that encourages employee contribution to ensure the department maintains an environment in which quality flourishes. Serves as a member/resource/liaison to the A&G Operations Team. Recommends resources to improve performance standards in terms of Appeals & Grievances. Collaborates with peers and colleagues within the organization to address process improvements, member's needs, department and organizational enhancements and communicate development as appropriate. Participates on internal and external committees as delegated or assigned. Serves as a consultant to other departments or organizations as needed. Performs other duties as assigned. Education Required Associate's Degree in NursingEducation Preferred Bachelor's Degree in NursingExperience Required: At least 8 years of RN acute/clinical care experience. At least 2 years in a lead/supervisory experience. Equivalency: Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement. Preferred: Previous experience in Medicare/ Medicaid in a managed care/ health plan environment.Skills Required: Knowledge of state, federal and regulatory requirements in Appeals/Care/Case/Utilization Management/Quality. Strong verbal and written communication skills. Computer literacy with proficiency in Microsoft Word, Excel, etc. and ability to learn core departmental computer systems and software. Excellent organizational, time management, and interpersonal skills. Must be detailed-oriented, energetic, and an enthusiastic team player. Must be able to work independently. Licenses/Certifications Required Registered Nurse (RN) - Active, current and unrestricted California LicenseLicenses/Certifications Preferred Required Training Physical Requirements LightAdditional Information 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 assigned 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) 
