Nursing Jobs in Cypress, CA
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$76,425 - $139,028 / year
Job Description Job Summary Provides support for clinical facility site reviews. Under the supervision of leadership, uses clinical judgement within appropriate scope to independently conduct reviews and other monitoring activities for primary care providers, specialty care providers, skilled nursing facilities, sub-acute facilities, intermediate care facilities for developmentally disabled and community-based adult services sites, and other network providers. Completes reviews in alignment with local/state/federal requirements and internal Molina policies and procedures. Leverages survey review data to develop reports, document review outcomes, and identify opportunities for ongoing program improvement. Contributes to overarching strategy to provide quality and cost-effective member care. Job Duties • Conducts onsite, virtual and desktop facility site reviews, medical record reviews, specialty site reviews, Physical Accessibility Review Surveys (PARS), focused reviews, and other reviews as needed. • Completes all aspects of facility site reviews using appropriate assessment tool and established regulations/policies and procedures. • Reviews and audits provider quality programs, processes, and policies. • Documents discussions and correspondence in facility site review (FSR) files as appropriate. • Communicates and coordinates information and findings from site visits between FSR leadership, internal and external staff and customers. • Documents review outcomes and other details in designated database, develops reports, and ensures proper document collection throughout the review process. • Assists with quality interventions program documentation and updates, reports, presentations, etc. • Represents as a Molina liaison to address provider questions and concerns. • Collaborates directly with providers to provide education, resources and tools to assist in achieving and maintaining compliance with local, state, and federal requirements. • Provides tools and resources to promote and facilitate access to preventive and other important health services. • Supports the development of facility site review policies, procedures and processes. • Identifies and supports ongoing program improvement opportunities and initiatives. • Provides technical assistance to providers, medical groups, and internal partners to enable delivery of accessibility information to Molina members. • Participates in PARS trainings, internal/departmental/collaborative meetings, workgroups and completes required compliance trainings to maintain necessary knowledge and skills. • Maintains confidentiality and compliance with Health Insurance Portability and Accountability Act (HIPAA) standards. • Collaborates with leadership to establish individual and team goals. • Completes special assignments and projects as assigned. Job Qualifications REQUIRED QUALIFICATIONS: • At least 2 years of related clinical/quality review experience, or equivalent combination of relevant education and experience. • Active and unrestricted Registered Nurse (RN) license in state of practice. • For the state of California: Current Department of Health Care Services (DHCS), Clinical Site Review (CSR) certification, or ability to be certified within 1 year of taking position. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements. Requires same-day out-of-office travel 50- 75% of the time, depending on location. (on average the nurses are in the field 3-4 days per week) • May require multiple days’ out of town overnight travel 0 - 30% of the time, depending upon location. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and situations. • Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. • Critical thinking skills. • Proactive, detail oriented, and organized. • Ability to work cross-functionally across a highly matrixed organization. • Effective verbal and written communication skills. • Microsoft Office suite and applicable software programs proficiency. PREFERRED QUALIFICATIONS: • Managed care experience. • Quality improvement and/or auditing experience. • Successful completion of PARS training and/or PARS certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $76,425 - $139,028 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 
$101,721 - $198,356 / year
JOB DESCRIPTION Job Summary Work Location: California - Ability to work remote, but selected candidate must reside in the state of California. This position requires California RN Licensure. Candidates must have significant IPA delegation experience. Leads and directs a multidisciplinary team of healthcare services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team responsible for assessing, facilitating, planning and coordinating integrated delivery of care across the continuum. Participates with senior leadership to establish strategic plans and objectives. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Directs and oversees one or more of the following key health care services functions: care management, utilization management, care transitions, long-term supports and services (LTSS), behavioral health, nurse advice line, and/or other special programs. • Develops, implements and/or monitors standardized protocols for clinical and non-clinical team activities to facilitate integrated proactive care coordination/care review and management. • Develops and promotes interdepartmental integration and collaboration to enhance clinical services. • Collaborates with and keeps healthcare services senior leadership informed of operational issues, staffing, resources, system and program needs and presents solutions/action plans for issues. • Facilitates and participates in committees, task forces, work groups and multidisciplinary teams as needed to promote a standardized enterprise-wide approach to healthcare services programs. • Ensures monthly auditing is occurring with appropriate follow-up. • Engages in clinical training activities and outcomes. • Develops and mentors direct reporting healthcare services leadership. • Local travel may be required (based upon state/contractual requirements). Required Qualifications •At least 8 years health care experience, and at least 5 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. • At least 3 years health care management/leadership required. • Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. • Experience working within applicable state, federal, and third party regulations. • Ability to manage conflict and lead through change. • Operational and process improvement experience. • Ability to work cross-collaboratively across a highly matrixed organization. • Ability to prioritize and manage multiple deadlines. • Excellent organizational, problem-solving and critical-thinking skills. • Strong written and verbal communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification. • Medicaid/Medicare population experience. • Clinical experience. #PJHS #LI-AC1 To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $101,721 - $198,356 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 
$114,732.80 - $165,214.40 / year
Schedule: 7PM-7AM | 12 hours | 30 hours weekly Purpose Statement/Position Summary The Registered Nurse in the NICCU conducts patient assessments, participates in the development of the plan of care, implements and evaluates care according to patient specific age and/or developmental needs. Collaborates with other health care team members in the delivery of care. Employee will follow applicable policies and procedures in handling supplies, pharmaceuticals, and equipment. Newborn and Infant Critical Care Unit (NICCU): A 58-bed Level IV unit that serves as a national and international referral center, dedicated to the care of critically ill newborns and infants with complex medical and surgical diagnoses. Our team manages a diverse patient population ranging from 22-week micro-preemies to infants beyond their first year of life. The unit's specialized therapies include Extracorporeal Membrane Oxygenation (ECMO), Cardio-Renal Pediatric Dialysis Emergency Machine (CARPEDIEM), Neuro Critical Care with Whole Body Cooling (Therapeutic Hypothermia), and Bronchopulmonary Dysplasia (BPD) with a specialized Home Ventilator Program, while also providing some of the most highly specialized neonatal and infant surgical services available. These advanced therapies and services create a unique environment for cutting-edge care, learning, and professional growth. Minimum Qualifications/Work Experience 1+ year experience as an RN. Pediatric experience preferred. Broad knowledge of patient care principles and equipment; CHLA patient care policies and procedures. Ability to assess effectiveness of patient care; maintain a calm demeanor and assist in crises and emergencies; prioritize tasks for complex patient care; communicate tactfully, professionally, and effectively, verbally and in writing. Education/Licensure/Certification BSN preferred. Associates Degree in Nursing. Current licensure as a Registered Nurse in the state of California. Current American Heart Association CPR certification, Current American Heart Association PALS card and NRP Certification. 
