Nursing Jobs in Lawndale, CA
$87,035 - $187,460 / year
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Title: Oak Street Health New Graduate Nurse Practitioner Fellowship Location: Glendale - 2240 E 53rd St B 1, Indianapolis, IN 46220 Fellowship Program Description: Start your NP career in the future of healthcare! Oak Street Health’s NP Fellowship in Adult Primary Care is in formal collaboration with the University of Michigan School of Nursing. The program is set in the revolutionary value-based care model, which rewards healthcare companies for the quality of their care, not the quantity. This 12-month paid fellowship will provide all the necessary skills, support, and learning required to become a highly confident and competent clinician for older adults. During the program, fellows spend time building their own patient panel, learning from a multitude of preceptors, and engaging in didactic content that aims to build on, not repeat, graduate training. All fellows commit to working at Oak Street for at least a year following program completion, but we hope they will spend their careers at Oak Street improving the health of communities across the country. The program has two concurrent cohorts starting in September and March of every year. The annual salary for this location is $100,000. Benefits: One-year paid program. Fellows commit to a second year of employment with Oak Street Health following the fellowship and future opportunities to continue working with us. Competitive salary relative to other fellowship programs. Generous benefits, including vacation time, health insurance, retirement benefits, and CME stipend. Small patient panels and true interprofessional care team collaboration. Dedicated time for teamwork to ensure optimal health outcomes for your patients. Requirements: Family, adult, or adult-gerontology primary care nurse practitioners who graduated or will graduate from their programs between December 2024 and May 2026. Must currently reside in, or be willing to relocate to, the Fellowship program location for at least the next two years. Have not yet worked as an NP. Minimum of one year experience, within the last five years, working as an adult RN. Minimum GPA of 3.0 in NP program. Have passed, or in the process of, passing NP board examinations by 6/6/2026. Currently holds or will hold by 8/3/2026 an active, non-probationary state NP license. A genuine passion for adult primary care. A supportive attitude toward our patient population of older adults. Embrace teamwork and the opportunity to collaborate with brilliant colleagues. Want to be a part of an innovative model focused on empirically guided population health. Language skills are strongly preferred, depending on clinic location. Someone who embodies being “Oaky”. What does being “Oaky” look like? Radiating positive energy Assuming good intentions Creating an unmatched patient experience Driving clinical excellence Taking ownership and delivering results Being relentlessly determined Application Timeline Please upload your CV using the link below. Once submitted, it will be reviewed by the Fellowship staff. If you meet the eligibility criteria, you will be invited to complete the full application. This next phase includes two short essays, the submission of three professional references, and supporting materials such as transcripts and applicable licenses. We encourage prospective applicants to begin identifying references early. For the NP Fellowship Program, we require one (1) reference from a current or recent supervisor, and two (2) references from a Preceptor, Program Director, or Faculty member. Why Oak Street Health? Oak Street Health is on a mission to “rebuild healthcare as it should be'', providing personalized primary care for older adults on Medicare, with the goal of keeping patients healthy and living life to the fullest. Our innovative care model is centered right in our patient’s communities and focused on the quality of care over the volume of services. We’re an organization on the move! With over 160 locations and an ambitious growth trajectory, Oak Street Health is attracting and cultivating team members who embody “Oaky” values and passion for our mission. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $87,035.00 - $187,460.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area. 
$110,000 - $115,000 / year
We save lives while providing the opportunity for people to realize their healthy selves. Nurse Manager Monte Nido Clementine Calabasas, CA Monte Nido Clementine Calabasas , located in Calabasa s , C A , is a residential treatment program exclusively for adolescents seeking treatment for Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, or Exercise Addiction. At Clementine , we support adolescents and their families on the path to full recovery by preparing each adolescent to navigate the challenges of life free of the eating disorder. We provide empathy, education, and support to families as partners in the recovery process. We help each adolescent to replace the eating disorder with healthy skills and a deep understanding of how to live a life that reflects their own unique individuality. We are seeking a full-time Nurse Manager to lead the Nursing team. Salary : $110,000 - $115,000/ year Schedule : Monday - Friday, daytime hours; some on-call availability required #LI-ONSITE Total Rewards: Discover a rewarding career with us and enjoy an array of comprehensive benefits! We prioritize your success and well-being, providing: Competitive compensation Medical, dental, and vision insurance coverage ( Benefits At a Glance ) Retirement Company-paid life insurance, AD&D, and short-term disability Employee Assistance Program (EAP) Flexible Spending Account (FSA) Health Savings Account (HSA) Paid time off Professional development And many more! We are committed to creating a diverse environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. Responsibilities Include: Essential Duties and Responsibilities • Recruit, hire and train adequate and competent department staff. • Monitor and evaluate all aspects of the facility medication management. • Meet with all clients as needed to ensure best practice care, treatment and services are provided. • Communicate as needed with pertinent outside treatment professionals and in a manner consistent with MNA processes. • Ensure both admission and discharge processes are maintained to ensure continuity of care with respect to relevant nursing and medical issues. • Maintain the nursing schedule as per the facility and organization needs including but not limited to managing vacation requests, sick leave, new hire, and additional staffing requirements. • Ensuring facilitation of performance evaluations as required for all direct reports and implementing merit increases as approved by the Clinical Director. • Produce and maintain communication which provides detailed and useful information on all current clients. • Ensure quality nursing notes are entered for each patient every shift. • Organize and facilitate laboratory work per provider orders. • Ensure that an admission nursing assessment and care plan(s) for each client are complete per program policy. • Maintain confidentiality of protected health information. • Provide ongoing training as needed to existing nursing personnel. • Ensure effective communication between nursing staff and collaborating disciplines. Other Duties and Responsibilities • Ensure provider order for admission is present upon client admission to the program. • Organize and document required monthly nursing meeting and other necessary meetings as warranted. • Manage the maintenance of all nursing related spaces and equipment. • Ensure proper nursing documentation is entered for each client including but not limited to daily shift notes, weekly updates, treatment plans, treatment plan updates, contact notes and discharge summaries. • Review and document employee performance 90 days after hire, annually, and as needed per company policy. • Manage performance improvement/disciplinary action as warranted according to policy and document performance management as required. • Nurse Manager or designee to attend and present all necessary nursing related information in weekly staffing for all clients. • Coordinate with providers to ensure that necessary communication and documentation is maintained; specifically relating to the ongoing medical, psychiatric, nursing and medication management of client care. • Responsible for oversight of facility’s infection control/prevention program. • Responsible for ensuring that there are on-call nursing staff always designated. • Receive facility-related calls and come in for uncovered shifts when all other options have been exhausted (per-diem staff, part-time staff, full-time staff and Agency are unavailable). • Attend Nursing Leadership calls/meetings monthly, and as needed. • Assist with insurance issues as needed or designated by Vice President of Nursing Operations, or designee. • Coordinate and ensure that all admission requirements are completed per organization policy. • Ensure proper destruction / return of all medications is completed per policy and regulatory standards. • Maintain adequate inventory and supply of necessary nursing related items in accordance with monthly operational budget. • Assist with additional program needs as requested by the Vice President of Nursing Operations, Clinical Director or designee. • Seek opportunities to increase self-knowledge to improve the quality of client care provided. • Maintain compliance with Joint Commission and State/License regulatory standards and company policy. • In an emergency or declared state of emergency, may be required to stay onsite as a part of the emergency team until emergency has ended. • Demonstrates ability to identify and refer legal and/or ethical issues in client care to the Clinical Director or Director of Compliance. Qualifications: BSN from an accredited school of nursing, and current RN licensure Minimum of two (2) years of experience Previous experience managing nursing operations, either in a residential or hospital eating disorder setting, is preferred Excellent communication, patient relations, and time management skills; safety awareness; and the ability to work as a member of a treatment team are all required #clementine 
$160,000 - $190,000 / year
About Atria: The Atria Health Institute is a membership-based primary and specialty health care practice with a focus on prevention and longevity. We bring together a multidisciplinary team of renowned physicians to provide proactive, preventive, and precision-based care for Atria members and their families. All care, including primary care, advanced screening and diagnostics, urgent care, specialty care, 24/7 home visits, and imaging is included in members’ annual fee. Our mission is to make healthspan and lifespan equal for all by translating science into medicine in real-time, all while bringing humanity back into health care. Delivering such robust, personalized, and preventive health care is complex and requires a team-wide dedication to excellence. After successfully opening our flagship Institute in New York in 2022 and expanding to South Florida in 2024, we are now bringing the Atria experience to the West Coast with the launch of our Los Angeles Institute in summer 2026. Overview We are seeking a highly skilled and motivated Nurse Practitioner (NP) or Physician Assistant (PA) to join our dynamic Endocrinology & Metabolic Health team in a fast-paced outpatient multispecialty setting. The ideal candidate will possess a strong clinical background in endocrinology, excellent communication and patient management skills, and a commitment to delivering high-quality, patient-centered care, preventatively minded endocrine and metabolic health care in a concierge practice model. Key Responsibilities Comprehensive Patient Care Conduct thorough patient evaluations, utilizing your skills to gather medical histories, perform physical exams, and assess diagnostic results in patients with endocrine disorders. Diagnose and manage common endocrine conditions, such as diabetes, overweight and obesity, thyroid disorders, adrenal disorders, and metabolic syndrome. Order and interpret lab tests and imaging studies, collaborating with the endocrinologist to develop tailored treatment plans. Develop and implement individualized treatment plans in collaboration with the attending physician and multidisciplinary team. Monitor patient progress, adjusting treatment plans as necessary and providing patient education regarding disease management and lifestyle modifications in a manner that is personalized, proactive, responsive, and collaborative Perform and oversee dynamic endocrine testing procedures, interpretation of lab results, imaging studies, and other diagnostic tests. Provide exceptional patient care by maintaining strong communication with patients and their families regarding treatment plans and health education. Empowering Patient Education Educate patients about their diagnoses and treatment options, providing them with the knowledge and tools they need for effective self-management. Guide patients in lifestyle modifications, from dietary adjustments to exercise regimens, fostering a proactive approach to their health. Create a supportive environment that encourages open communication and engagement, helping patients stay committed to their care plans. Collaborative Team Environment Work hand-in-hand with the endocrinologist, care coordination team and multidisciplinary clinical team to deliver seamless, comprehensive concierge care. Engage in team meetings and case discussions, contributing your insights to optimize patient management strategies. Administrative Excellence Maintain accurate and timely documentation in our electronic health record (EHR) system, ensuring the highest standards of patient care. Participate in the development and implementation of clinical protocols that enhance our practice and patient outcomes. Contribute to quality improvement initiatives, monitoring patient satisfaction and outcomes to drive continual enhancement of our services. Ongoing Professional Development Stay at the forefront of endocrinology by engaging in continuous education and training, ensuring your skills and knowledge remain cutting-edge. Participate in professional organizations and attend conferences to enrich your expertise and foster networking opportunities. 5 days x 8 hour shifts Current CA License required as NP for specialty, or current CA Licensed PA Minimum of 3+ years of experience in endocrinology required. Experience in endocrinology is required; a passion for prevention is essential. 2+ year’s experience as a practicing NP or PA-C Strong clinical assessment skills and a comprehensive understanding of endocrine disorders. BLS & ACLS certification from the American Heart Association Availability to be flexible with weekend coverage Thrives in a fast-paced, growing environment Internal Medicine, Primary Care, Urgent Care, Emergency, and Family Medicine (Preferred) Compensation: $160,000 - $190,000, depending on years of experience At Atria, we are proud to offer every member of the Atria team: Excellent health and wellness benefits, 100% paid by Atria effective date of hire Flexible Time Off 401k match at 4% effective date of hire Opportunity to participate in continuing medical education programs for maintenance of Continued Medical Education and CEUs for professional licensure Fitness Perks including Wellhub + Time to give back and make an impact in underserved communities $160,000 - $190,000 / year
About Atria: The Atria Health Institute is a membership-based primary and specialty health care practice with a focus on prevention and longevity. We bring together a multidisciplinary team of renowned physicians to provide proactive, preventive, and precision-based care for Atria members and their families. All care, including primary care, advanced screening and diagnostics, urgent care, specialty care, 24/7 home visits, and imaging is included in members’ annual fee. Our mission is to make healthspan and lifespan equal for all by translating science into medicine in real-time, all while bringing humanity back into health care. Delivering such robust, personalized, and preventive health care is complex and requires a team-wide dedication to excellence. After successfully opening our flagship Institute in New York in 2022 and expanding to South Florida in 2024, we are now bringing the Atria experience to the West Coast with the launch of our Los Angeles Institute in summer 2026. Overview We are seeking a highly skilled and motivated Nurse Practitioner (NP) or Physician Assistant (PA) to join our dynamic Endocrinology & Metabolic Health team in a fast-paced outpatient multispecialty setting. The ideal candidate will possess a strong clinical background in endocrinology, excellent communication and patient management skills, and a commitment to delivering high-quality, patient-centered care, preventatively minded endocrine and metabolic health care in a concierge practice model. Key Responsibilities Comprehensive Patient Care Conduct thorough patient evaluations, utilizing your skills to gather medical histories, perform physical exams, and assess diagnostic results in patients with endocrine disorders. Diagnose and manage common endocrine conditions, such as diabetes, overweight and obesity, thyroid disorders, adrenal disorders, and metabolic syndrome. Order and interpret lab tests and imaging studies, collaborating with the endocrinologist to develop tailored treatment plans. Develop and implement individualized treatment plans in collaboration with the attending physician and multidisciplinary team. Monitor patient progress, adjusting treatment plans as necessary and providing patient education regarding disease management and lifestyle modifications in a manner that is personalized, proactive, responsive, and collaborative Perform and oversee dynamic endocrine testing procedures, interpretation of lab results, imaging studies, and other diagnostic tests. Provide exceptional patient care by maintaining strong communication with patients and their families regarding treatment plans and health education. Empowering Patient Education Educate patients about their diagnoses and treatment options, providing them with the knowledge and tools they need for effective self-management. Guide patients in lifestyle modifications, from dietary adjustments to exercise regimens, fostering a proactive approach to their health. Create a supportive environment that encourages open communication and engagement, helping patients stay committed to their care plans. Collaborative Team Environment Work hand-in-hand with the endocrinologist, care coordination team and multidisciplinary clinical team to deliver seamless, comprehensive concierge care. Engage in team meetings and case discussions, contributing your insights to optimize patient management strategies. Administrative Excellence Maintain accurate and timely documentation in our electronic health record (EHR) system, ensuring the highest standards of patient care. Participate in the development and implementation of clinical protocols that enhance our practice and patient outcomes. Contribute to quality improvement initiatives, monitoring patient satisfaction and outcomes to drive continual enhancement of our services. Ongoing Professional Development Stay at the forefront of endocrinology by engaging in continuous education and training, ensuring your skills and knowledge remain cutting-edge. Participate in professional organizations and attend conferences to enrich your expertise and foster networking opportunities. 5 days x 8 hour shifts Current CA License required as NP for specialty, or current CA Licensed PA Minimum of 3+ years of experience in endocrinology required. Experience in endocrinology is required; a passion for prevention is essential. 2+ year’s experience as a practicing NP or PA-C Strong clinical assessment skills and a comprehensive understanding of endocrine disorders. BLS & ACLS certification from the American Heart Association Availability to be flexible with weekend coverage Thrives in a fast-paced, growing environment Internal Medicine, Primary Care, Urgent Care, Emergency, and Family Medicine (Preferred) Compensation: $160,000 - $190,000, depending on years of experience At Atria, we are proud to offer every member of the Atria team: Excellent health and wellness benefits, 100% paid by Atria effective date of hire Flexible Time Off 401k match at 4% effective date of hire Opportunity to participate in continuing medical education programs for maintenance of Continued Medical Education and CEUs for professional licensure Fitness Perks including Wellhub + Time to give back and make an impact in underserved communities $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 (UM) Claims Review Nurse RN II is responsible for conducting clinical review of medical claims to ensure services were medically necessary, appropriately documented, accurately billed, and compliant with established clinical policies and regulatory standards. This position supports payment integrity initiatives through retrospective and pre-payment review processes, helps reduce unnecessary denials, and monitors for potential fraud, waste, and abuse (FWA). The UM Claims Review Nurse RN II collaborates closely with internal teams to ensure accurate adjudication and compliance. This position collaborates closely with internal stakeholders and external entities to support compliance with state, federal, and accreditation requirements. Duties Perform claims pre-payment review by supporting the Claims team in evaluating flagged claims prior to adjudication to ensure services are medically necessary, documentation supports billed services, coding is accurate and aligned with authorization when applicable, and unnecessary denials are reduced through accurate clinical validation. Conduct comprehensive retrospective reviews, applying established clinical criteria, policies, and regulatory guidelines to determine medical necessity and appropriateness of services rendered. Complete Provider Dispute Review (PDR) clinical evaluations for disputed claims requiring medical necessity scrutiny and clinical determination. Apply internal and external clinical policies, including those developed by the Clinical Policy team, to ensure compliance with guidelines intended to limit fraud, waste, and abuse (FWA). Ensure adherence to federal and state regulations, and accreditation standards. Monitor trends related to contested claims and identify potential FWA concerns; escalate findings in accordance with organizational compliance protocols. Collaborate with internal teams to support payment integrity initiatives. Provide clear, well-documented clinical rationales supporting approval, denial, or adjustment decisions. Maintain productivity and quality standards consistent with departmental expectations. Participate in audits, regulatory readiness activities, and quality improvement initiatives as assigned. Document review outcomes clearly and accurately within designated systems, ensuring audit readiness and traceability. Remain current with evolving clinical guidelines, coding standards, reimbursement methodologies, and regulatory requirements. Perform other duties as assigned. Duties Continued Education Required Associate's Degree in Nursing Education Preferred Bachelor's Degree in Nursing Experience Required: At least 5 years of experience in Clinical Nursing. At least 3 years of experience with Medi-Cal and Medicare in a managed care environment. Experience in performing and creating clinical documentation. Experience in regulatory compliance for a health plan. Preferred: Experience with Provider Dispute Review (PDR) processes. Experience applying clinical guidelines (e.g., InterQual, MCG, or internally developed criteria) in processes. Prior experience in payment integrity, compliance, or fraud, waste, and abuse (FWA) monitoring. Skills Required: Knowledge of medical necessity criteria, reimbursement principles, and managed care operation. Working knowledge of clinical policies. Working knowledge of CPT/HCPC Codes, and ICD-10. Proficient in claims processing systems and electronic medical record platforms. Strong problem-solving skills and the ability to identify discrepancies, assess risk, and recommend actionable solutions. Strong verbal and written communication skills. Ability to work independently with a high degree of initiative, organization, and self-direction. Ability to work effectively with diverse teams in cross-functional work groups. Ability to multitask, re-prioritize tasking, and streamline day-to-day operations. Familiarity with regulatory and accreditation standards (e.g., CMS, Medi-Cal, NCQA). Understanding of the managed care industry and market conditions. High organizational and time-management skills. Preferred: Strong analytical and investigative skills with the ability to synthesize clinical and claims information into clear, defensible determinations are highly valued. Advanced knowledge of medical necessity criteria tools such as InterQual or MCG. Extensive knowledge in claims reviews includes retrospective reviews, pre-payment claims review, and medical necessity determinations. Licenses/Certifications Required Registered Nurse (RN) - Active, current and unrestricted California License Licenses/Certifications Preferred 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) $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 Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides direct assistance to members with health care access or benefit coordination issues, ensuring that clinical grievances, complaints and complex issues are investigated and resolved to the member's satisfaction in a manner consistent with L.A. Care, Centers of Medicare and Medicaid Services (CMS) and regulatory guidelines. Benefit coordination may involve coordinating multiple L.A. Care products, Fee for services (FFS) Medi-Cal/Medicare, or commercial insurance. Duties Conducts intake/triage and appropriate classification of Clinical A&G, and Pharmacy requests and makes accurate judgment on appeal, grievance, Provider Claim Disputes, medical records or other issues and follows procedures on how to handle each type of request and route to the appropriate area within the department. Investigation, and resolution of clinical member complaints (grievances/appeals) utilizing all regulatory requirements. Investigation, and resolution of clinical Provider Complaints/ Provider Data Resolution (PDR) (grievances/appeals) utilizing regulatory and internal guidelines and Service Level Agreement (SLA). Identification of Expedited Cases and resolution within 72 hours. Works with the external providers and Participating Physician Group's (PPG) representatives to obtain relevant medical records and communication documentation. Prepares resolved complaint files for Centers for Medicare and Medicaid Services (CMS), DMHC, and external review organization (QIO or IRE). Process the case thru to effectuation and final case documentation in the A&G system of record. Investigation and preparation of State Fair Hearing cases as assigned. Prepares resolved complaint files for CMS external review organization - Quality Improvement Organization (QIO) or Independent Review Entity (IRE). Conducts reviews and presents to physicians, provider disputes which would be based on medical necessity reviews. Prepares authorizations, after approval by the Medical Director. When necessary, outreaches to providers, vendors, hospitals, and members to request necessary information or to provide case status and/or next steps. In instances where necessary, sends written notifications to appropriate parties. All interactions including verbal outreach and written communication will be documented in the A&G system of record. Participates inter-rater reliability training and assessments. Perform other duties as assigned. Duties Continued Education Required Associate's Degree in Nursing Education Preferred Bachelor's Degree in Nursing Experience Required: At least 5 years of experience in Clinical RN. At least 2 years in Medicare/ Medicaid in a managed care/ health plan environment. Skills Required: Excellent interpersonal and communication skills. Computer literacy and adaptability to computer learning. Time management and priority setting skills. Must be organized and a team player Able to work effectively with various internal departments/service areas, L.A. Care's plan partners, participating provider groups, and other external agencies. Good working knowledge of regulatory requirements/standards. 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, 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) 
$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 Clinical Quality Nurse Reviewer RN II, under the purview of the Utilization Management (UM) Department Leadership Team, is responsible for conducting and tracking targeted and random internal department documentation audits. This role ensures that UM practices and supporting documentation are compliant with all regulatory requirements. The Incumbent also serves as a Subject Matter Expert during external audits as well as leads pre- and post-audit preparation/follow-up. This position actively participates in the development and review of policies and procedures to certify compliance with regulatory guidelines and mandates. This position focuses on UM cases for all lines of business to identify areas of opportunity for increasing positive audit outcomes and improved service to L.A. Care’s membership. This position is responsible for identifying and monitoring staff (non-clinical, nurse, and physician) performance against key performance indicator trends that warrant recognition or remediation. This position performs data mining and analysis and creates reports on audit findings, as well as makes recommendations, to submit to the department's Quality Assurance Team and UM Management. Duties Facilitates the development, review, and revision of organizational and departmental process flows to ensure compliance with relevant regulatory, organizational, and departmental guidelines. Keenly focuses on practices and documentation of clinical staff, serving as a resource on state and federal industry mandates applicable to UM functions. Generates results of findings, enhances, and analyzes various reports related, but not limited to, quality and accuracy of case documentation. Works with department leadership to assess for all opportunities related to quality improvements. Compiles and presents quality report cards that measure adherence to quality and regulatory compliance. Keeps UM Leadership apprised of departmental and industry trends, deficiencies, and any potential risks, and collaborates with the team to develop and execute mitigation efforts. Serves as a consultant to the organization's Compliance team on an ad hoc basis. Performs other duties as assigned. Duties Continued Education Required Associate's Degree in Nursing Education Preferred Bachelor's Degree Master's Degree in Nursing Experience Required: At least 5 years of experience in Clinical Nursing. Minimum of 2 years of auditing clinical documentation. Active participation in at least two state regulatory audits and one federal regulatory audits. Previous experience with Medi-Cal and Medicare in a managed care environment and experience with mitigation planning and implementation. Preferred: Experience performing clinical documentation for a health plan. Active participation in at least three state regulatory audits, at least one National Committee for Quality Assurance (NCQA) audit and/or Centers for Medicare and Medicaid Services (CMS) audit. Background in teaching and/or clinical education. Skills Required: Superior verbal and written communication skills. Advanced computer proficiency in both Microsoft Word and Excel. Strong analytical and team building skills. Ability to work independently and be self-directed. Ability to work effectively with diverse team members. Strong problem-solving skills. Ability to multitask and streamline day-to-day operations. Ability to translate regulatory requirements into auditable tools. Preferred: Proven ability to lead successful performance improvement projects. Licenses/Certifications Required Registered Nurse (RN) - Active, current and unrestricted California License Licenses/Certifications Preferred 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) 
