Nursing Jobs in Los Alamitos, 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 Payment Integrity Nurse Coder RN III is responsible for investigating, reviewing, and providing clinical and/or coding expertise/judgement in the application of medical and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The position serves as a subject matter expert (SME), performing medical records reviews to include quality audits as well as validation of accuracy and completeness of all coding elements. The position is also responsible for guidance related to Payment Integrity initiatives to include concept and cost avoidance development. This position trains and mentors Payment Integrity Nurse Coder, RN staff. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff. Duties Performs Quality Audits to include validation of accuracy and completeness of ICD, Rev Code, CPT, HCPCs, APR, DRG, POA, and all relevant coding elements. Audits can include inpatient, outpatient, and professional claims. Serves cross functionally with Utilization Management, Medical Directors, and other internal teams to assist in identification of overpayments as well as other projects. Serves as SME for all Payment Integrity functions to include both Retrospective Data Mining as well as Pre-Payment Cost Avoidance. Identifies trends and patterns with overall program and individual provider coding practices. Responsible for training and mentoring Payment Integrity Nurse Coder, RN staff. Supports the creation and execution of strategies that determine impact of opportunity and recover overpayments as well as prospective internal controls preventing future overpayments of each applicable pipeline opportunity. Works with both internal and external groups to define and develop cost avoidance measures to ensure continued success. Identifies and defines Payment Integrity issues and reviews and analyzes evidence, utilizes data for the purpose of verifying errors and identifying systemic errors, works as an active team member during scheduled engagements and work collaboratively to achieve the goals of the team, and provides feedback to the team lead on any issues identified during research or claims review. Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed. Performs other duties as assigned. Duties Continued Education Required Associate's Degree in Nursing Education Preferred Bachelor's Degree in Nursing Experience Required: At least 8 years of clinical RN experience. At least 3 years of experience in utilization management or clinical coding. Investigation and/or auditing experience. Skills Required: Knowledge in CPT, HCPCS, ICD-9, ICD-10, Medicare, and Medicaid rules and regulations. Knowledge of healthcare reimbursement concepts, health insurance business, industry terminology, and regulatory guidelines. Working knowledge of claims coding and medical terminology. Solid understanding of standard claims processing systems and claims data analysis. Strong project leadership and management skills required; ability to prioritize, plan, and handle multiple tasks/demands simultaneously. Excellent interpersonal, verbal, and written communication skills required with excellent analytical and problem-solving skills. Detail oriented and ability to thrive in fast-paced work environment. Must be collaborative and have the ability to establish credibility quickly with all levels of management across multiple functional areas and be able to present findings across all departments. Must be familiar with coordinating benefits between health plan payers. Advanced knowledge of Microsoft Office suite, including Word, Excel and PowerPoint. Licenses/Certifications Required Registered Nurse (RN) - Active, current and unrestricted California License Certified Professional Coder (CPC) designation by the American Academy of Professional Coders and/or Certified Coding Specialist (CCS) designation by the American Health Information Management Association (AHIMA). 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) 
Description In this role, you will provide direct nursing care, infusion therapy and documentation to patients in the Community Oncology Practice. Major functions include: patient assessment, patient evaluation and preparation and administration of chemotherapeutic agents and other intravenous drugs, patient education and psychosocial support. Incumbent will travel to various clinic locations to provide support. Salary range: $70.59/hr - $106.80/hr 
$145,600 - $240,240 / 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). Essential Duties: 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. Manages treatment of hospitalized patients. 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. Directly performs or orders appropriate diagnostic studies and interprets finished results. Develops and implements long and short range treatment plans. Performs procedures as defined by approved credentialing privileges. Writes orders to increase, decrease or change medication, subject to checking and counter-signing by physician. Initiates consultations and monitors scheduling of patients for special tests. 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. Instructs and counsels patients and families regarding preventive care, medical problems, psychological problems, and use of prescribed treatments and drugs. Serves as a resource for clinic support staff (RN, LVN, MA, and others). Acts as 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. Researches community resources for referral of patients. Refers patients to most appropriate resource based on patients’ medical needs and condition. 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. Participates in in-service education programs and professional associations. 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. 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). ◦ 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 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 $145,600.00 - $240,240.00. 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$143465.htmld 
$85,600 - $141,200 / year
Who Are We? Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Claim, Nurse - Medical Case Manager Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $85,600.00 - $141,200.00 Target Openings 1 What Is the Opportunity? This is a unique opportunity to have face to face time while working as a case manager. This position will work out of a Concentra clinic in Irwindale, CA. The clinic is located at 6520 Irwindale Ave #100 Irwindale, CA 91702. Bilingual candidates encouraged to apply. Under moderate supervision, provide office based telephonic and/or in-person medical case management supporting Concierge locations with emphasis on early intervention, return to work planning, coordination of quality medical care on claims involving disability and medical treatment as well as in-house medical reviews as applicable to claim handling laws and regulations. Responsible for helping to ensure injured parties receive appropriate treatment directly related to the compensable injury or assist claim handlers in managing medical treatment to an appropriate resolution. What Will You Do? Meet with injured employees face to face following office visits at a provider's medical facility to assist with the claim process and ensure compliance with their medical treatment plan. Contact customer, medical provider and injured parties on claims involving medical treatment and /or disability to coordinate appropriate medical care and return to work. Develop strategies to facilitate an injured employee's return to work and achieve maximum medical improvement. Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim. Coordinate with medical providers to ensure the injured employee is actively participating in a viable treatment plan. Evaluate medical treatment requests to ensure that they are reasonable and necessary based upon jurisdictional guidelines. Engage specialty resources as needed to achieve optimal resolution (Dial-a-doc, physician advisor, peer reviews, MCU). Partner with Claim Professional to provide medical information and disability status necessary to create an overall strategy to achieve an optimal outcome. Utilize internal Claim Platform Systems to manage all claim activities on a timely basis. Utilize Preferred Provider Network per jurisdictional guidelines. Partner with Claim Professional to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves. Submit accurate billing documentation on all activities as outlined in established guidelines. Customer Engagement. Participate in Telephonic and/or onsite File Reviews. Respond to inquiries - oral and written. Keep injured worker apprised of claim status. In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) and/or certifications may be required to comply with state and Travelers requirements. Generally, License(s) are required to be obtained within three months. Perform other duties as assigned. What Will Our Ideal Candidate Have? RN or LVN Disability case management experience. Prior clinical experience. Familiarity with URAC standards. Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making. Communication: Expresses, summarizes and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language and terminology. Ability to effectively present file resolution to internal and/or external stakeholders. Negotiation: Intermediate ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise. General Insurance Contract Knowledge: Ability to understand policies and contracts, as they apply to policy conditions. Principles of Investigation: Intermediate investigative skills. Follows a logical sequence of inquiry with a goal of securing information about the work accident, resulting injury, anticipated treatment, job duties and any material factors that may impact recovery and return to work. Value Determination: Basic ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves. Legal Knowledge: Basic knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry. Medical knowledge: Thorough knowledge of the nature and extent of injuries, periods of disability, and treatment needed. WC Technical: intermediate ability to demonstrate understanding of WC Products and ability to apply available resources and technology to manage treatment plans and assist with claim resolution. Demonstrate a clear understanding and ability to work within jurisdictional parameters within their assigned state. Customer Service: Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes. Teamwork: Advanced ability to work together in situations when actions are interdependent and a team is mutually responsible to produce a result. Planning & Organizing: Advanced ability to establish a plan/course of action and contingencies for self or others to meet current or future goals. Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Clinical Research Counselor (CRC), or Certified Rehab Registered Nurse (CRRN). What is a Must Have? Registered Nurse; Licensed Practical Nurse or Licensed Vocational Nurse. What Is in It for You? Health Insurance : Employees and their eligible family members – including spouses, domestic partners, and children – are eligible for coverage from the first day of employment. Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit http://careers.travelers.com/life-at-travelers/benefits/ . 
