Nursing Jobs in Cypress, CA
Description In this role, you will provide direct nursing care, infusion therapy and documentation to patients in the Community Oncology Practice. Major functions include: patient assessment, patient evaluation and preparation and administration of chemotherapeutic agents and other intravenous drugs, patient education and psychosocial support. Incumbent will travel to various clinic locations to provide support. Salary range: $70.59/hr - $106.80/hr 
$85,600 - $141,200 / year
Who Are We? Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Claim, Nurse - Medical Case Manager Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $85,600.00 - $141,200.00 Target Openings 1 What Is the Opportunity? This is a unique opportunity to have face to face time while working as a case manager. This position will work out of a Concentra clinic in Irwindale, CA. The clinic is located at 6520 Irwindale Ave #100 Irwindale, CA 91702. Bilingual candidates encouraged to apply. Under moderate supervision, provide office based telephonic and/or in-person medical case management supporting Concierge locations with emphasis on early intervention, return to work planning, coordination of quality medical care on claims involving disability and medical treatment as well as in-house medical reviews as applicable to claim handling laws and regulations. Responsible for helping to ensure injured parties receive appropriate treatment directly related to the compensable injury or assist claim handlers in managing medical treatment to an appropriate resolution. What Will You Do? Meet with injured employees face to face following office visits at a provider's medical facility to assist with the claim process and ensure compliance with their medical treatment plan. Contact customer, medical provider and injured parties on claims involving medical treatment and /or disability to coordinate appropriate medical care and return to work. Develop strategies to facilitate an injured employee's return to work and achieve maximum medical improvement. Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim. Coordinate with medical providers to ensure the injured employee is actively participating in a viable treatment plan. Evaluate medical treatment requests to ensure that they are reasonable and necessary based upon jurisdictional guidelines. Engage specialty resources as needed to achieve optimal resolution (Dial-a-doc, physician advisor, peer reviews, MCU). Partner with Claim Professional to provide medical information and disability status necessary to create an overall strategy to achieve an optimal outcome. Utilize internal Claim Platform Systems to manage all claim activities on a timely basis. Utilize Preferred Provider Network per jurisdictional guidelines. Partner with Claim Professional to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves. Submit accurate billing documentation on all activities as outlined in established guidelines. Customer Engagement. Participate in Telephonic and/or onsite File Reviews. Respond to inquiries - oral and written. Keep injured worker apprised of claim status. In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) and/or certifications may be required to comply with state and Travelers requirements. Generally, License(s) are required to be obtained within three months. Perform other duties as assigned. What Will Our Ideal Candidate Have? RN or LVN Disability case management experience. Prior clinical experience. Familiarity with URAC standards. Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making. Communication: Expresses, summarizes and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language and terminology. Ability to effectively present file resolution to internal and/or external stakeholders. Negotiation: Intermediate ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise. General Insurance Contract Knowledge: Ability to understand policies and contracts, as they apply to policy conditions. Principles of Investigation: Intermediate investigative skills. Follows a logical sequence of inquiry with a goal of securing information about the work accident, resulting injury, anticipated treatment, job duties and any material factors that may impact recovery and return to work. Value Determination: Basic ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves. Legal Knowledge: Basic knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry. Medical knowledge: Thorough knowledge of the nature and extent of injuries, periods of disability, and treatment needed. WC Technical: intermediate ability to demonstrate understanding of WC Products and ability to apply available resources and technology to manage treatment plans and assist with claim resolution. Demonstrate a clear understanding and ability to work within jurisdictional parameters within their assigned state. Customer Service: Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes. Teamwork: Advanced ability to work together in situations when actions are interdependent and a team is mutually responsible to produce a result. Planning & Organizing: Advanced ability to establish a plan/course of action and contingencies for self or others to meet current or future goals. Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Clinical Research Counselor (CRC), or Certified Rehab Registered Nurse (CRRN). What is a Must Have? Registered Nurse; Licensed Practical Nurse or Licensed Vocational Nurse. What Is in It for You? Health Insurance : Employees and their eligible family members – including spouses, domestic partners, and children – are eligible for coverage from the first day of employment. Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit http://careers.travelers.com/life-at-travelers/benefits/ . 
$206,311 - $350,729 / year
Salary Range: $206,311.00 (Min.) - $278,520.00 (Mid.) - $350,729.00 (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 Medical Director, Utilization Management provides clinical oversight of authorization decision making and processing, pre and post payment claims review activities, payment integrity clinical validation and program integrity functions. This position requires evaluation and insight for both medical and behavioral health cases. In this position, the Medical Director supports the development of and ensures the application of clinical policies are consistent with evidence-based medicine and regulatory requirements. The Medical Director collaborates with internal teams to support timely consistent and defensible clinical decisions and promotion of appropriate high-value care. In support of payment and program integrity initiatives, the Medical Director reviews clinical documentation to validate coding accuracy and appropriateness and completion of billed services. This position plays a critical role in the mitigation of Fraud, Waste and Abuse (FWA) and requires proactive analysis of service level utilization data to identify trends, outliers and emerging risk areas and recommend corrective action to minimize utilization variation, prevent improper payments and ensure financial stewardship. Works collaboratively with Health Services departments and key organizational stakeholders, to ensure alignment of utilization management, claims review, and regulatory compliance activities. Partners with executive leadership, clinical teams, and external stakeholders to improve outcomes, support regulatory compliance, and advance organizational goals. Duties Provides physician leadership within the Health Services division, with primary responsibility for overseeing Utilization Management (UM) reviews, conducting medical claims review under Payment Integrity and supporting Behavioral Health (BH). Applies clinical expertise and evidence-based criteria to behavioral health and medical/surgical services, conducting claims reviews in compliance with regulatory timeframe requirements. Leads efforts to strengthen Payment Integrity by overseeing clinical validation of requested services, ensuring alignment between documentation and medical necessity. Analyzes utilization and claims data to identify trends, outliers, cost drivers, and opportunities to reduce unnecessary services and prevent improper payments. Identifies and mitigates Fraud, Waste, and Abuse (FWA) risks by detecting patterns, and partners with internal teams as appropriate. Develops, approves, and updates medical policies, procedures, and standards of care based on current, evidence-based practices. Oversees and reviews the delivery of patient care to ensure it meets quality standards and regulatory guidelines. Guides quality assurance and performance improvement (QAPI) programs and participates in quality review committees. Maintains and enforces compliance with all federal and state laws, accreditation standards (such as NCQA), and other regulatory requirements. Assists in the preparation and monitoring of departmental budgets, including managing costs and resource utilization. Performs other duties as assigned. Duties Continued Education Required Doctor of Medicine (M.D.) Education Preferred Experience Required: At least 8 years of experience in medical management, managed care and quality management. Experience in Payment Integrity. Experience in maintaining liaison with Federal, State, and local bodies and medical organizations. Experience in performance management and possession of strong analytic ability. Extensive post-medical degree experience in clinical practice. Significant experience in a clinical development, medical affairs, or management role within the biotech, pharmaceutical, or healthcare industry. Proven experience in a physician leadership role, including managing teams. Preferred: Experience with Medicaid managed care and/or governmental programs for underserved, safety net populations including women, children, person with disabilities, seniors, and those of varied ethnic and cultural backgrounds. Skills Required: Ability to provide leadership to physicians, nurses, and other health care professionals, and an interest and involvement in the affairs of the health care community. Excellent written and verbal communication skills with the ability to effectively collaborate with multidisciplinary teams and senior leadership. Strong leadership, consensus-building, and stakeholder engagement skills, as well as a commitment to evidence-based practice, continuous quality improvement, regulatory compliance, and health equity. Demonstrated ability for teamwork and collaborative problem-solving. Commitment to patient-centered, value-based care. Strong leadership presence with the ability to lead, mentor, and motivate a team. Exceptional presentation skills to effectively convey complex medical concepts to diverse audiences. Ability to think strategically and take a broad, business-oriented perspective. Strong analytical and problem-solving skills, with a data-driven approach to evaluating programs. Ability to work in a fast-paced, dynamic, and often ambiguous environment. Licenses/Certifications Required Board Certified, preferably in Internal Medicine, Family Medicine, Emergency Medicine or Psychiatry. Clinical License to practice or an Administrative License to review Utilization Management cases. - Active, current and unrestricted California License Licenses/Certifications Preferred Certification as a Certified Medical Director (CMD) Required Training Physical Requirements Light Additional 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) $145,600 - $240,240 / 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). 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). The annual base salary range for this position is $145,600.00 - $240,240.00. 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$143465.htmld 
