Nursing Jobs in Los Alamitos, 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) 
$167,960 - $274,726 / year
The Nurse Practitioner (NP) has a specialized skill and knowledge related to the setting in which they practice and perform physical exams, collects and documents data, conducts approved diagnostic and therapeutic procedures, orders and schedules laboratory studies and professional consultations, prescribes appropriate interventions and medications, and provides direct patient care services, according to established evidence-based clinical practice standards. The NP contributes to excellence in patient care, research, teaching, consulting, and provides leadership to the organization and advance practice profession. Duties may include but not limited to obtaining patient health histories and complete physical examinations, documenting findings noting pertinent normal and abnormal findings, ordering and interpreting appropriate diagnostic and laboratory tests, and performing procedures as needed within specialty area. The NP also helps facilitate safe and efficient operational flow of the patient through their continuum of care. The NP will function as a part of inter-professional teams by communicating, planning, and implementing care directly with other healthcare professionals, including but not limited to physicians, pharmacists, office support staff, and other advance practice providers (APPs). Departmental Specific Summary The Nurse Practitioner is under general supervision and in accordance with standardized procedures, incumbent performs physical examinations and treats common episodic and chronic health care problems, counsels patients and families, monitors patient progress, assists with medical research projects. Resource for RNs, LVNs, and support staff. Works in collaboration with other health care team members, consulting and referring as appropriate, but retains responsibility for ongoing clinical management of the patient. Essential Duties 1. Conducts in-depth interviews with patients and/or family, constructs comprehensive medical histories, performs initial and periodic physical examinations and explores patient’s interpretation of health needs. Identifies and treats patients’ diseases (e.g. post-implant VAD care, heart failure, etc.). Manages treatment of hospitalized patients. 2. Identifies patient’s educational needs and provides health related information to enhance patient’s and family’s understanding of medical condition and related treatments. Obtains informed consent for procedures that will be performed Instructs and counsels patients and families regarding care, medical problems, psychological problems and use of prescribed devices, treatments and drugs. 3. Directly performs or orders appropriate diagnostic studies and interprets finished results. 4. Develops and implements long and short range treatment plans. 5. Performs procedures such as obtaining specimens, performing injections, immunizations, lumbar punctures, skin biopsies, suturing, wound care and management of conditions produced by trauma or infection. 6. Writes orders to increase, decrease or change medication, subject to checking and counter-signing by physician. 7. Initiates consultations and monitors scheduling of patients for special tests. 8. Identifies records pertinent progress of patients, updating and summarizing charts, changing orders when appropriate and notifying the responsible physician of changes in the patient’s condition. 9. Instructs and counsels patients and families regarding preventive care, medical problems, psychological problems, and use of prescribed treatments and drugs. 10. Acts as the lead in the clinics (e.g. being the resource for RN, LVN, and support staff) and acts as the liaison with governmental agencies such as Center for Disease Control and National Institute of Health. Assists with medical research projects, following medical research protocols. Obtains Investigational Review Board approval for treatment protocols. 11. Researches community resources for referral of patients. Refers patients to most appropriate resource based on patients’ medical needs and condition. 12. Maintains compliance with established University and department policies and procedures, quality assurance, safety, environmental, infection control and complies with requirements of accreditation and regulatory agencies. 13. Participates in in-service education programs and professional associations. 14. Performs other duties as assigned. Required Qualifications: Req Master's degree Graduate from an accredited school of Nursing (MSN). Req 5 years Clinical nursing experience. Pref 3 years Experience as NP in specialty area preferred Req Other certifications and experience as required per specialty area Req Must have excellent communication skills, including the ability to speak, read and write English proficiently. Req Knowledge of medical procedures and conditions and ability to understand, follow and successfully perform duties. Preferred Qualifications: Pref 3 years Experience as NP in specialty area preferred Required Licenses/Certifications: Req Registered Nurse - RN (CA Board of Registered Nursing) Req Nurse Practitioner - NP (CA Board of Registered Nursing) Req Nurse Practitioner Furnisher (CA DCA) Current license to furnish medications in the State of California. Req DEA Certificate Drug Enforcement Agency (DEA) Certificate issued by the U.S. Department of Justice for Schedule II-V controlled substances. Req NP Board Certified Possession of National Board Certification in Nurse Practitioner area of specialty accredited by Accreditation Board of Specialty Nursing (ABSNC) or National Commission for Certifying Agencies (NCCA). (*Exempt from NP Board Certification requirement if hired/transferred prior to 12/2011.) ◦ If work in Hospital/Acute Care Setting must have Certification from the American Nurses Credentialing Center (ANCC) or American Association of Critical-Care Nurses (AACN) as an Acute Care Nurse Practitioner (ACNP) or Adult Gerontology Acute Care Nurse Practitioner (AGACNP) upon hire. ▪ (*Grandfathered from Acute Care Certification requirement if hired/transferred prior to 12/2015.) Req Basic Life Support (BLS) Healthcare Provider from American Heart Association 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 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) Keck Hospital of USC, a 343-bed acute care hospital, provides exceptional and innovative care for complex medical and surgical conditions across a wide range of specialties. The hospital’s world-renowned physicians deliver compassionate, customized, patient-centered care and treat the most acutely ill patients with highly innovative techniques and treatment plans. As a leading academic medical center, hundreds of clinical trials are currently taking place at Keck Hospital and its affiliated research institutions, giving patients access to novel and promising therapies that are generally not available elsewhere. Every day at Keck Hospital, physicians, nurses and staff go beyond the science of exceptional medicine to bring patients breakthroughs in the art of caring. Join this world-class team providing highly specialized care, up-to-the-minute research, and innovative clinical trials. The annual base salary range for this position is $167,960.00 - $274,726.00. 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. 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