Nursing Jobs in Lomita, 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 (UM) Admissions Liaison RN II is primarily responsible for receiving/reviewing admission requests and higher level of care (HLOC) transfer requests from inpatient facilities within regular timelines. Reviews clinical data in real-time and post admission to issue a determination based on clinical criteria for medical necessity. Assures timely, accurate determination and notification of admission and inter-facility transfer requests. Generates approval, modification, and denial communications for inpatient admission requests. Actively monitors for appropriate level of care (inpatient vs. observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director, on requests where determination requires extended review. Collaborates with the inpatient care team for facilitation/coordination of patient transfers between acute care facilities. Acts as a department resource for medical service requests/referral management and processes. Actively participates in the discharge planning process, including providing clinical review and authorization for alternate levels of care, home health, durable medical equipment, and other discharge needs. Provides support to the inpatient review team as necessary to ensure timely processing of concurrent reviews. Duties Provides the primary clinical point of contact for inpatient acute care hospitals requesting Inpatient care/post-stabilization admission requests, Higher level of care transfers and other emergent transfers or needs. Ensures appropriate determination for admission requests/HLOC transfers based on clinical data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses members for admission needs, including, but not limited to, bed and accepting physician availability. (40%) Establishes and maintains ongoing communication with internal stakeholders and external customers while securing the L.A. Care member's admission or inter-facility transfer. Interfaces with physicians, house supervisors, and other hospital delegates to ensure that telephone triage results in appropriate patient placement. (10%) Applies clinical expertise and the nursing process to triage and prioritize admission acuity, servicing as an expert clinical resource for patient placement while utilizing medical knowledge and experience to facilitate consensus-building and development of satisfactory outcomes (10%) Continually seeks new ways to improve processes and increase efficiencies. Takes the initiative to communicate recommendations to UM Leadership. (5%) Completes all inpatient and discharge planning requests appropriately and timely including, but not limited to: Skilled nursing facility, outpatient needs (home health, physical therapy, infusion), and case management referrals (5%) Performs prospective, concurrent, post-service, and retrospective claim medical review processes. Utilizes clinical judgement, independent analysis, critical-thinking skills, detailed knowledge of medical policies, clinical guidelines and benefit plans to complete reviews and determinations within required turnaround times specific to the case type. Identifies requests needing medical director review or input and presents for second level review (20%) Performs other duties as assigned. (10%) Duties Continued Education Required Associate's Degree in NursingEducation Preferred Bachelor's Degree in NursingExperience Required: Minimum of 7 years of clinical experience in an acute hospital setting. Previous experience to have a strong understanding of Utilization Management/Case Management practices including, but not limited to, placement (with level of care) criteria (MCG, InterQual), concurrent review, and discharge planning. Preferred: Consistent Critical Care experience (Emergency Department, Intensive Care, Labor & Delivery) background highly desirable. Experience in bed placement decision-making highly desirable. Skills Required: Must be computer literate, with expertise in Outlook, Word, Excel, PowerPoint. Provision of excellent customer service required due to frequent communication with providers and other members of the interdisciplinary team 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. 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 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)American Case Management Association (ACM)Required Training Physical Requirements LightAdditional Information Required: Attend mandatory department trainings as scheduled Financial Impact: Management of all medical services has a tremendous potential impact on the cost of health care and budget. This position manages determinations to ensure services requested are medically appropriate and provided in the most cost effective manner without compromising quality healthcare delivery. Types of Shift: Day (7:00am - 3:30pm), Evening (3:00pm -11:30 pm), Night (11:00pm -7:30am). Float (Varies)* *All possible shifts. 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) 
$128,500 - $298,100 / year
Description Under the direct supervision of the Clinical Director, the Clinical Nurse Manager independently coordinates all outpatient services for the Department of Head and Neck Surgery. The nurse manager’s responsibilities include direct supervision of all clinical and back-office staff at the Westwood campus: NPs, RNs, LVNs, medical assistants, sterile processing technicians, scribes, and hospital lab technicians at all departmental sites, including developing and coordinating work schedules, taking disciplinary actions when needed, and completing annual performance evaluations. This role includes active participation in budget planning and management, decision about medical and surgical equipment acquisition (and assist with maintaining service contracts), and maintenance of complete and accurate charge documents and charge capture and provide oversight, within EMR (EPIC/CareConnect) while identifying areas of improvement. The Clinical Nurse Manager takes a lead role in performance improvement activities and patient satisfaction initiatives; ensures quality patient care is provided in accordance with UCLA policies and procedures, JCAHO, Title 22, OSHA, and DHS standards; runs weekly and monthly reporting on clinic staffing, productivity metrics, budget adherence, patient volumes, and others and report weekly utilizing Microsoft Office and EMR to Clinical Director. The position also develops and maintains all SOPs/competencies for all the clinical staff in the Department of Head and Neck Surgery. This position will require occasional (approx. 1x/month) travel to community Head and Neck sites with Clinical Director for site visits. Salary Range: $128,500 - $298,100 annually 
$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) $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, 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 late spring 2026. This is an extraordinary opportunity to join our founding LA team. You will be responsible for bringing rigor and thoroughness to the development of clinical operations in our largest clinic yet, as well as maintaining and supporting our strong and inclusive organizational culture and performance standards. In this hands-on role, you will collaborate with clinical, finance, technology, care coordination, hospitality, content, events, and experience and to drive excellence. About the Role: We are seeking Advanced Care Providers (Nurse Practitioners and Physician Assistants) to join our expanding Cardiology team and collaborate closely with our Chief Medical Officers. Ideal candidates will demonstrate a commitment to providing high-quality patient care and bring an innovative, forward-thinking approach to their work. Essential Job Duties: Preferred prior cardiac experience inpatient and/or outpatient Patient Assessment and Diagnosis: Nurse Practitioners and Physician Assistants (NPs/PAs) partner with Cardiologists to perform comprehensive health assessments, including medical history, physical examinations, and diagnostic tests, to identify patients' health status and needs. Diagnose acute and chronic cardiac health conditions, formulate differential diagnoses, and develop appropriate treatment plans Treatment and Management: NPs/PAs collaborate with Cardiologists to facilitate appropriate testing. Manage chronic conditions, monitor patients' progress, and adjust treatment plans as necessary to optimize health outcomes. Complete Prior Authorizations Health Promotion and Disease Prevention: NPs/PAs educate patients and families about health promotion strategies, cardiovascular disease prevention measures, and lifestyle modifications to improve overall health and well-being Collaborative Care: NPs/PAs collaborate with interdisciplinary healthcare teams, including physicians, nurses, care coordination, and other healthcare professionals, to coordinate patient care effectively. Clinical Care: NPs/PAs will be required to perform clinical skills that include but are not limited to; phlebotomy, IV insertion, holter placements, ambulatory blood pressure monitors, and EKG Documentation and Recordkeeping: NPs/PAs prepare charts for Cardiologists, including patient histories, assessments, diagnoses, treatment plans, and progress notes. They will assist in completing any forms for patient care such as Radiology questionnaires. They ensure compliance with legal and regulatory requirements, as well as organizational policies and procedures Ethical and Legal Compliance: NPs/PAs adhere to ethical principles and professional standards of practice, maintaining confidentiality, integrity, and respect for patients' rights and dignity. They comply with legal and regulatory requirements governing nursing practice, licensure, and scope of practice Compensation: $160,000 - $190.000, based on years of experience 5 days x 8 hour shifts Current CA License required as NP for specialty, or current CA Licensed PA 2+ year’s experience as a practicing NP or PA-C 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) At Atria, we are proud to offer every member of the Atria team: Excellent health and wellness benefits, fully covered by Atria, effective date of hire OneMedical membership for employees & dependents, giving access to 24/7 virtual care Fertility & family planning Company-covered preventive health screenings through partner hospitals (calcium score) Fitness Perks, including Wellhub + 401k contributions and 4% match starting after 6 months Flexible Time Off Continuing medical education (CME) and CEU support for professional licensure 
$129,521.60 - $161,865.60 / year
WelbeHealth PACE helps seniors stay in their homes and communities by providing comprehensive medical care and community-based services. We serve the most vulnerable seniors with better quality and compassion in a model value-based model. Reporting to the Clinical Nurse Manager, the Assistant Clinical Nurse Manager is accountable for both people management and RN-level nursing care. Under the direction of the Executive Director, the WelbeHealth Assistant Clinical Nurse Manager directs the day-to-day work at the clinic, oversees the clinic staff, and coordinates clinical flow to ensure that services are provided effectively and quality of care standards are met. This role is different because Assistant Clinical Nurse Managers at WelbeHealth: Have the opportunity to grow their career at a faster rate than in other settings Integrate patient-centered care with operational leadership to ensure efficient day-to-day clinic operations We care about our team members. That’s why we offer: Medical insurance coverage (Medical, Dental, Vision) Work/life balance - We mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days 401K savings + match Comprehensive compensation package including base pay and bonus And additional benefits! On the day-to-day, you will: Provide leadership, oversight, and performance management to RN, LVN, and MA staff, ensuring they all have role clarity and the required training to perform their functions at the top of their license Oversee clinic function to ensure both chronic and acute participant needs are addressed properly Liaise with the Complex Care team on smooth transitions of care to meet post-discharge needs Develop workforce plans and ensure appropriate staffing, recognizing the diverse experience levels of staff members and the unique needs of participants Participate actively in direct participant care to ensure needs are met, practicing within the RN level of care Manage direct reports including hiring, training, supervising, and mentoring, as well as exercise flexibility in performing assignments as business needs evolve Job requirements include: Graduate of an accredited school of nursing with unencumbered RN license required; bachelor’s degree (BSN) preferred Minimum of two (2) years of nursing experience in a clinical setting with a frail or elderly population Minimum of one (1) year of supervisory experience with demonstrated ability to mentor and develop team members preferred Minimum of one (1) year of case management, care coordination, or related specialty preferred Experience leading in a data-driven organization, leveraging reports and data to prioritize and manage people and project Must be willing to work a varied schedule that may include nights, weekends, and overtime We are seeking Assistant Clinical Nurse Managers that ideally have outpatient/clinical experience. If you’re ready to join a holistic care team that values both its participants and providers, we’d love to hear from you! Compensation consists of base salary plus bonus. WelbeHealth offers a competitive total rewards package that includes a 401(k) match, comprehensive healthcare coverage, and a broad range of additional benefits. Actual compensation will be determined based on experience and relevant qualifications. Compensation Offering $129,521.60 — $161,865.60 USD COVID-19 Vaccination Policy At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations. Our Commitment to Diversity, Equity and Inclusion At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law. Beware of Scams Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to fraud.report@welbehealth.com $150,009.60 - $190,216 / year
Primary Care Provider WelbeHealth PACE (Program of All-Inclusive Care for the Elderly) provides seniors with the opportunity to continue living in their homes and in their communities. Our innovative and comprehensive range of medical services to participants is what ignites our passion to treat the whole person and not just the symptoms! We employ a collaborative interdisciplinary team (IDT) approach to evaluate and guide participant care. At the direction of the Medical Director, the Primary Care Provider works collaboratively with WelbeHealth Physicians and the IDT to complete assessments, plan primary care, and educate WelbeHealth participants and their families. This role is different because Primary Care Providers at WelbeHealth: Serve a smaller patient caseload, providing the opportunity to form long-term relationships with participants and practice true value-based care Collaborate with other providers, therapists and disciplines as part of the IDT We care about our team members. That’s why we offer: Competitive compensation with quarterly bonus Medical insurance coverage (Medical, Dental, Vision) Work/life balance - We mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days 401K savings + match Comprehensive compensation package including base pay and bonus CME reimbursement And additional benefits! On the day-to-day, you will: Provide continuous medical coverage to participants, as well as perform comprehensive in-person assessments including initial, semi-annual, and unscheduled assessments Collaborate with Physicians and other IDT members to develop participant care plans, oversee and ensure effective care coordination, and arrange discharge planning from acute or long-term settings Assist in maintaining participant care in skilled nursing facilities and residences, making regular visits as dictated by participant need Review outcomes and utilization data, including hospitalizations and use of specialists, to establish best practices and policy improvements Job requirements include: Graduation from an accredited school of nursing Certificate as a Nurse Practitioner or Physician Assistant with prescriptive authority RN state license Minimum of two (2) years of experience working with frail or elderly populations Current knowledge of chronic care, geriatric issues, and best practices Reliable means of transportation Able and willing to take part in rotating night and weekend call We are seeking Primary Care Providers that ideally have experience caring for senior with complex care needs (Medicare/Medicaid population). If you’re ready to join a holistic care team that values both its participants and providers, we’d love to hear from you! Compensation consists of base salary plus bonus. WelbeHealth offers a competitive total rewards package that includes a 401(k) match, comprehensive healthcare coverage, and a broad range of additional benefits. Actual compensation will be determined based on experience and relevant qualifications. Compensation Offering $150,009.60 — $190,216 USD COVID-19 Vaccination Policy At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations. Our Commitment to Diversity, Equity and Inclusion At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law. Beware of Scams Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to fraud.report@welbehealth.com 
