Nursing Jobs in Duarte, 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 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) 
The Registered Nurse delivers professional nursing care to the patient whose needs range from uncomplicated to highly complex. Establishes a helping relationship using a holistic approach. The RN ensures quality and appropriateness of care for all age groups in the unit-specific patient population to include neonates, children, adolescents, adults, and geriatrics. Coordinates care planning with other disciplines. Requirements: Graduate nurse of an accredited school of nursing – BSN or ASN Registered Nurse, licensed in the state. BLS, ACLS, and PALS – must be completed only by American Heart Association. Benefits : Medical, dental and vision coverage is provided for all full time and part time employees* Medical is 100% employer paid including dependents* Employee Assistance Program Basic Life and AD&D 401k plan with company match Generous PTO plan* Pet Insurance Discount Program* Employee Discount Program* *Per diem staff ineligible 
$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. 
