Nursing Jobs in Kagel Canyon, CA
$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 Lead Appeals and Grievances RN is responsible for assisting with the development of a successful and cohesive Appeals and Grievance (A&G) clinical unit. This position is responsible for the quality review of complex and/or escalated clinical A&G cases for all lines of business (LOB). The Lead will assist in identifying areas of improvement in increasing positive audit outcomes and improved Customer Service to L.A. Care’s (LAC) membership. This position will ensure the effective investigation and resolution of clinical grievances, appeals, complaints, and complex issues in alignment with L.A. Care policy and procedures along with all relevant regulatory guidelines. Leads and works closely with assigned team daily. This position will mentor, coach, and may provide feedback to management on performance of staff. Ensure team effectiveness and project completion. Duties Review and process complex and/or escalated clinical A&G cases. Analyze the patient medical records, clinical documentation, and insurance policies to determine medical necessity. Prepares and reviews A&G files for submission to providers and internal departments. Work with other departments to ensure all aspects of a case are appropriately managed. Conduct targeted and random clinical case audits to ensure that all regulatory and departmental guidelines, policies, procedures, and standards are met. Work closely with the leadership team to create and/or modify Desk Level Procedures and recommend enhancements to process and procedures. Assist the Clinical Supervisors in identifying deviations in performance and process changes are implemented to redirect performance to acceptable levels. Recommend and implement resolutions, new processes, and/or process improvement. Provide accurate and timely written statistical reports that include historical and/or current data to aid in projecting or evaluating compliance status. Identify and analyze trends in appeals and grievances to find the root cause of denials. Duties Continued Check, verify and ensure that all clinical A&G cases are processed accurately and within established timelines to meet or exceed member satisfaction goals and regulatory (CMS, DMHC, DHCS, NCQA), Health and Safety Code and company compliance. Maintain documentation of all communications in the A&G system to ensure thorough tracking of case status. Lead the work of assigned staff; regularly assigns and checks the work of others, providing guidance, training, and feedback on performance to department management. Work closely with management to review performance and quality standards on an ongoing basis. As well as motivational programs needed to achieve regulatory standards. Act as a back-up to the Supervisor in leading meetings and handling escalations as required. Perform other duties as assigned. Education Required Associate's Degree in Nursing for Registered Nurses Education Preferred Bachelor's Degree in Nursing for Registered Nurses Experience Required: At least 8 years of clinical appeals and grievances experience in a managed care, utilization management and/or case management setting, At least 2 years in Medicare/ Medicaid in a managed care/ health plan environment. At least 1 year of leading a process, program, or staff experience. Preferred: Clinical acute experience. Skills Required: Extensive knowledge of healthcare regulations and managed care guidelines Demonstrated ability to provide recommendations towards resolution. Strong critical thinking and problem-solving abilities to assess complex clinical cases and evaluate medical necessity. Ability to communication, conflict resolution, and motivational skills. Ability to work independently and closely with a team in a collaborative and interactive environment. Ability to adjust to changing circumstances within the team. Good verbal and written communication skills. Preferred: Strong project management skills with the ability to manage multiple training initiatives simultaneously. Licenses/Certifications Required Registered Nurse (RN) - Active, current and unrestricted California License Licenses/Certifications Preferred Required Training Physical Requirements Light Additional Information This position requires work after hours, on weekends, holidays, a hybrid remote schedule, and 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) 
$158,080 - $260,832 / year
The Supervisor works under the direction of the Associate Administrator of Advance Practice Providers, Department's Administration, and Medical Directors to provide both clinical services as well as leadership and managerial services . The Supervisor will facilitate safe and efficient operational flow of the dedicated patient population. The Supervisor is responsible for the application of the advance practice provider processes, supervision of clinical practice, education, leadership, and patient care management. This position 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. The Supervisor administrative duties include but are not limited to supervising NP's, PA's as assigned. Depending on location, may be supervising union employees. They will be responsible for annual reviews and employee counseling. The Supervisor works under the direction of the Associate Administrator, Department's Administrative, and Medical Directors to provide both clinical services as well as leadership and managerial services. The Supervisor will facilitate safe and efficient operational flow of the the patient population at Keck Medical Center, Arcadia Hospital, Verdugo Hills Hospital, and USC Care Clinics. The Supervisor is responsible for the application of the advance practice provider process, supervision of clinical practice, education, leadership, and patient care management. This position 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. The Supervisor administrative duties include but are not limited to supervising NP's, PA's, as assigned. They will be responsible for annual reviews and employee counseling. They will collaborate with Department Administrator and Medical Director. Essential Duties: Management: • Utilizes professional, respectful, effective communication to delegate and direct activities and assignments • Supervises, hires, educates, disciplines and evaluates the performance of Nurse Practitioner and Physician Assistant staff. Ensures performance appraisals are completed in a timely manner. Interviews Nurse Practitioner and Physician Assistant candidates and orients new employees. • Schedules, assigns daily duties, and assesses the general performance of the Nurse Practitioners and Physician Assistantin the department. Partners with management in making daily staffing assignments in accordance with budgeted hours per patient day and provides rationale for any staffing variances. • Completes an initial assessment at the beginning of the day. Oversees the staffing and operational needs of the unit and organization • Oversees the education and orientation of Nurse Practitioners and Physician Assistants and keeps abreast of current trends, quality issues and departmental affairs. Acts as a clinical resource and support . • Models compassion, understanding, problem solving and conflict resolution skills amongst the staff to assist patients and families having difficulty coping with their illness and/or hospitalization and maintains good public relations • Effectively collaborates with other disciplines and providers to meet the needs of patients and fellow staff members • Keeps informed of clinical / service / organizational updates / changes • Manages time effectively and able to organize and prioritize responsibilities. • Demonstrates enthusiasm and commitment to the service, department and organization’s mission and goals. • Participates in departmental or organizational activities as assigned Compliance and Performance Improvement: • Identifies and participates in data collection and process improvements related to Quality Indicators • Responsible for observing and adhering to the regulatory agency requirements. • Continually reassesses clinic or hospital needs. • Ensures patient care is delivered in accordance with professional regulatory standards. • Identifies potential barriers to efficient operational flow. • Evaluates and modifies current practices to assure the most efficient way to assure effective operational flow. • Identifies quality improvement issues and develops unit-based quality improvement programs, as well as standards of care and practice. • Oversees the quality assurance initiatives for the department. • Develops, implements, and evaluates the clinical collaborative practice agreements in the clinical area. • Consistently keeps current on clinical, department and medical center changes; shares information with staff members by participating in huddles and utilizing all forms of communication as directed by the department Manager. • Responsible for pursuing opportunities for professional development (e.g. certifications, nursing committees, unit based projects, research, published peer review article) and able to mentor and share knowledge to colleagues and other staff. Transfers learned scientific knowledge into practical application. • Models expertise through the application of evidenced-based practice in clinical decision-making. Maintains a current level of knowledge inclusive of Evidenced Based Practice relative to professional practice. • Participates in the evaluation of the cost effectiveness of services provided. • Ensures complete and accurate documentation. • Responsible for the routine update of required licenses and credentials as required by organization • Responsible for the update and implementation of organization/ department’s policies and procedures; demonstrates ability to access online manuals. • Ensures that documentation is complete and correct in Electronic Health Record Direct Patient Care Accountabilities: • Responsible for ensuring the measures based on the appropriate level of care expected: management of the care and the ability to manage the care of post cardiac procedure patients. • Appropriately completes patient assessments • Interprets assessment information and formulates diagnoses. • Develops Plans of Care with individualized interventions. Documents expected/projected patient outcomes. Reviews/Revises/Updates Plans of Care daily based on evaluation and interpretation of patient outcomes. • Completes patient care procedures correctly per policy at prescribed intervals. • Delegates tasks based on others’ scope of practice and competency. • Acts as patient advocate. • Ensures prompt response to service needs as appropriate . • Provides patient/family education as needed. • Collaborates with Case Manager and/or social work for any social needs encountered with population. • Utilizes patient care equipment appropriately and safely according to manufacture guidelines. • Communicates effectively with all members of the healthcare team including patient and family. Ensures timely communication of patient needs to Providers Performs other duties as assigned. • Examples: Enthusiastic participation in unit activities such as process improvement efforts, preceptor, peer education; changing assignment to meet patient needs, etc. Required Qualifications: Req Master's degree Master's Degree In Nursing as a Nurse Practitioner, OR Graduated from an Accredited Physician Assistant (PA) program Req 5 years Experience as nurse practitioner or physician assistant Req Demonstrated strong leadership abilities. Req Demonstrates professional, respectful, effective communication to delegate and direct activities and assignments Req Strong critical and strategic thinking, analytical and planning skills. Req Organization/time management skills. Req Excellent communication skills. Preferred Qualifications: Pref Lead/charge or supervisory experience Pref Experience in clinical specialty area Required Licenses/Certifications: Req Registered Nurse - RN (CA Board of Registered Nursing) *Exempt from RN if Physician Assistant Req Nurse Practitioner - NP (CA Board of Registered Nursing) *Exempt from NP if Physician Assistant Req Nurse Practitioner Furnisher (CA Board of Registered Nursing) *Exempt from NP Furnisher if Physician Assistant 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.) (**Exempt from NP Board Certification if Physician Assistant) Req Physician Assistant - PA (CA DCA) Current Physician Assistant (PA) License in the State of California (**Exempt from PA if Nurse Practitioner) National Commission on Certification of Physician Assistants (NCCPA) National Commission on Certification of Physician Assistants (NCCPA) (**Exempt from PA Certification if Nurse Practitioner) Req DEA Certificate Drug Enforcement Agency (DEA) Certificate issued by the U.S. Department of Justice for Schedule II-V controlled substances 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 $158,080.00 - $260,832.00. 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$149345.htmld 
$158,080 - $260,832 / year
The Supervisor works under the direction of the Associate Administrator of Advance Practice Providers, Department's Administration, and Medical Directors to provide both clinical services as well as leadership and managerial services . The Supervisor will facilitate safe and efficient operational flow of the dedicated patient population. The Supervisor is responsible for the application of the advance practice provider processes, supervision of clinical practice, education, leadership, and patient care management. This position 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. The Supervisor administrative duties include but are not limited to supervising NP's, PA's as assigned. Depending on location, may be supervising union employees. They will be responsible for annual reviews and employee counseling. The Supervisor works under the direction of the Associate Administrator, Department's Administrative, and Medical Directors to provide both clinical services as well as leadership and managerial services. The Supervisor will facilitate safe and efficient operational flow of the the patient population at Keck Medical Center, Arcadia Hospital, Verdugo Hills Hospital, and USC Care Clinics. The Supervisor is responsible for the application of the advance practice provider process, supervision of clinical practice, education, leadership, and patient care management. This position 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. The Supervisor administrative duties include but are not limited to supervising NP's, PA's, as assigned. They will be responsible for annual reviews and employee counseling. They will collaborate with Department Administrator and Medical Director. Essential Duties: Management: • Utilizes professional, respectful, effective communication to delegate and direct activities and assignments • Supervises, hires, educates, disciplines and evaluates the performance of Nurse Practitioner and Physician Assistant staff. Ensures performance appraisals are completed in a timely manner. Interviews Nurse Practitioner and Physician Assistant candidates and orients new employees. • Schedules, assigns daily duties, and assesses the general performance of the Nurse Practitioners and Physician Assistantin the department. Partners with management in making daily staffing assignments in accordance with budgeted hours per patient day and provides rationale for any staffing variances. • Completes an initial assessment at the beginning of the day. Oversees the staffing and operational needs of the unit and organization • Oversees the education and orientation of Nurse Practitioners and Physician Assistants and keeps abreast of current trends, quality issues and departmental affairs. Acts as a clinical resource and support . • Models compassion, understanding, problem solving and conflict resolution skills amongst the staff to assist patients and families having difficulty coping with their illness and/or hospitalization and maintains good public relations • Effectively collaborates with other disciplines and providers to meet the needs of patients and fellow staff members • Keeps informed of clinical / service / organizational updates / changes • Manages time effectively and able to organize and prioritize responsibilities. • Demonstrates enthusiasm and commitment to the service, department and organization’s mission and goals. • Participates in departmental or organizational activities as assigned Compliance and Performance Improvement: • Identifies and participates in data collection and process improvements related to Quality Indicators • Responsible for observing and adhering to the regulatory agency requirements. • Continually reassesses clinic or hospital needs. • Ensures patient care is delivered in accordance with professional regulatory standards. • Identifies potential barriers to efficient operational flow. • Evaluates and modifies current practices to assure the most efficient way to assure effective operational flow. • Identifies quality improvement issues and develops unit-based quality improvement programs, as well as standards of care and practice. • Oversees the quality assurance initiatives for the department. • Develops, implements, and evaluates the clinical collaborative practice agreements in the clinical area. • Consistently keeps current on clinical, department and medical center changes; shares information with staff members by participating in huddles and utilizing all forms of communication as directed by the department Manager. • Responsible for pursuing opportunities for professional development (e.g. certifications, nursing committees, unit based projects, research, published peer review article) and able to mentor and share knowledge to colleagues and other staff. Transfers learned scientific knowledge into practical application. • Models expertise through the application of evidenced-based practice in clinical decision-making. Maintains a current level of knowledge inclusive of Evidenced Based Practice relative to professional practice. • Participates in the evaluation of the cost effectiveness of services provided. • Ensures complete and accurate documentation. • Responsible for the routine update of required licenses and credentials as required by organization • Responsible for the update and implementation of organization/ department’s policies and procedures; demonstrates ability to access online manuals. • Ensures that documentation is complete and correct in Electronic Health Record Direct Patient Care Accountabilities: • Responsible for ensuring the measures based on the appropriate level of care expected: management of the care and the ability to manage the care of post cardiac procedure patients. • Appropriately completes patient assessments • Interprets assessment information and formulates diagnoses. • Develops Plans of Care with individualized interventions. Documents expected/projected patient outcomes. Reviews/Revises/Updates Plans of Care daily based on evaluation and interpretation of patient outcomes. • Completes patient care procedures correctly per policy at prescribed intervals. • Delegates tasks based on others’ scope of practice and competency. • Acts as patient advocate. • Ensures prompt response to service needs as appropriate . • Provides patient/family education as needed. • Collaborates with Case Manager and/or social work for any social needs encountered with population. • Utilizes patient care equipment appropriately and safely according to manufacture guidelines. • Communicates effectively with all members of the healthcare team including patient and family. Ensures timely communication of patient needs to Providers Performs other duties as assigned. • Examples: Enthusiastic participation in unit activities such as process improvement efforts, preceptor, peer education; changing assignment to meet patient needs, etc. Required Qualifications: Req Master's degree Master's Degree In Nursing as a Nurse Practitioner, OR Graduated from an Accredited Physician Assistant (PA) program Req 5 years Experience as nurse practitioner or physician assistant Req Demonstrated strong leadership abilities. Req Demonstrates professional, respectful, effective communication to delegate and direct activities and assignments Req Strong critical and strategic thinking, analytical and planning skills. Req Organization/time management skills. Req Excellent communication skills. Preferred Qualifications: Pref Lead/charge or supervisory experience Pref Experience in clinical specialty area Required Licenses/Certifications: Req Registered Nurse - RN (CA Board of Registered Nursing) *Exempt from RN if Physician Assistant Req Nurse Practitioner - NP (CA Board of Registered Nursing) *Exempt from NP if Physician Assistant Req Nurse Practitioner Furnisher (CA Board of Registered Nursing) *Exempt from NP Furnisher if Physician Assistant 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.) (**Exempt from NP Board Certification if Physician Assistant) Req Physician Assistant - PA (CA DCA) Current Physician Assistant (PA) License in the State of California (**Exempt from PA if Nurse Practitioner) National Commission on Certification of Physician Assistants (NCCPA) National Commission on Certification of Physician Assistants (NCCPA) (**Exempt from PA Certification if Nurse Practitioner) Req DEA Certificate Drug Enforcement Agency (DEA) Certificate issued by the U.S. Department of Justice for Schedule II-V controlled substances 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 $158,080.00 - $260,832.00. 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$149337.htmld 