Nursing Jobs in Pomona, CA
$102,000 - $115,000 / year
Manager - Risk Adjustment Department: Quality - Risk Adjustment Employment Type: Full Time Location: 600 City Parkway West 10th Floor, Orange, CA 92868 Reporting To: Nallammai Vijayakumar Compensation: $102,000 - $115,000 / year Description Astrana Health is seeking Manager - Risk Adjustment to oversee risk adjustment initiatives for the organization, including in-home health assessments, embedded NP, medical chart retrieval, HCC risk adjustment data & documentation integrity, and supporting vendor programs. This manager will also oversee implementation of programs designed to ensure all diagnosed codes and conditions are properly supported by appropriate documentation in patient chart. These programs include but are not limited to training and educational activities, Nurse Practitioner and AWV programs, clinical chart review programs, retrospective reviews, encounter submission, data reconciliation, and electronic data submission including supplemental data submissions Our Values: Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team What You'll Do Oversees daily regional operations of the coding and specialists’ team, retrospective and prospective review teams and programs and ensures the appropriate strategy, tactics and data capture processes are in place. Collaborate closely with providers and regional network leadership teams to implement risk adjustment education, processes, and programs effectively for accurate and compliant capture of members' conditions. Identify and analyze implications of key changes to the regulatory & policy environment on provider organizations in the areas of risk adjustment and compliance. Serves as the vendor(Chart review/AWV /Cozeva etc) and provider liaison to ensure coordination of efforts, effective relationship management, cost effectiveness, delivery of work product, quality of work, delivery of required training for internal associates and timely communication on all issues. Manage the regional employed NP program and the vendor driven AWV program Audits the chart review outcomes provided by the risk adjustment vendor and audits provider coding trends to identify potential gaps. Support effective business relationships with external entities, including payers and health plan partners with continuous focus on performance improvement related to population clinical quality and patient experience goals. Requires significant collaboration with internal stakeholders including, but not limited to, primary care section and specialty service lines, IT, business services and finance, contracting, compliance, as well as external entities and vendors will be required Manage regional Provider Incentive and Member Incentive Programs Recover dx codes from institutional encounters through hospitalists/encounters Roll out new regional programs as applicable to improve documentation and accurate coding Ensure the accuracy of risk data in and out of core systems Establish EMR connectivity with Astrana Health and provider group/IPA Ensure compliance with all applicable regulatory and accreditation guidelines such as CMS, NCQA, DMHC etc. Develop policy and procedures as required for departmental improvements. Complete special projects when required. Other duties as assigned Qualifications Bachelor’s Degree Current AAPC or AHIMA certification (CCS, CCS-P, CPC, CPC-H, CPC-P, RHIT, or RHIA) 5 years’ experience of risk adjustment, project management, operations, quality improvement or data analysis/reporting experience in the healthcare industry 5 years’ experience in managerial or supervisory capacity Previous experience in value-based revenue and risk adjustment improvement initiatives Experienced with health plan guidelines/criteria/ICE/CMS/NCQA/DMHC Ability to effectively present information within and outside the organization Advanced ability to manage and work with minimal supervision or absence of detailed instruction. Strong computer skills with proficiency using all Microsoft Office products, and demonstrated ability and willingness to learn new software. Excellent time management, project management, organizational and communication skills. Environmental Job Requirements and Working Conditions This is a remote position. Travel to corporate offices in Orange County, Alhambra, or Monterey Park may be required once a year. The national target pay range for this role is: $102,000 - $115,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors. Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation. Additional Information: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change. 
$121,680 - $200,772 / year
Serves as a valued member of the departmental management team as the RN Coordinator on the floor to provide guidance to other RNs, LVNs, MAs and other clinical staff or administrative staff if performing duties for a clinic. Performs complex and varied administrative and clinical assignments. Serves as a personal contact for physicians, staff, patients and outside departments in order to address problems, issues or concerns that require attention. Assists in management of clinical unit operations. Serves as the primary competency validator/educator for the clinical staff. Able to provide telephone triage for same day appointments, and oversees a team of triage nurses. In addition, as an integral part of the multidisciplinary team, the Registered Nurse utilizes the nursing process to provide therapeutic care to patients and their families in the outpatient setting, when required. Ensures patient's right to privacy, safety, and confidentiality is maintained. Maintains a safe environment in accordance with standards, policies, and safety regulations. Ensures compliance with infection control policies. Complex, independent problem solving when overseeing a team of clinical floor staff and patient care coordinators with overlap at multiple practice sites or overseeing patient care if working at a clinic. Other duties as assigned. Serves as a valued member of the departmental team in the role of RN Coordinator, providing guidance, clinical leadership, and professional expertise to RNs, LVNs, MAs, and other clinical or administrative staff supporting clinic operations. Performs complex and varied administrative and clinical coordination assignments. Serves as a primary professional contact and resource for physicians, staff, patients, and outside departments to address complex clinical, operational, and patient-care coordination issues. Collaborates with management in clinical unit operations, workflow planning, and quality initiatives, and assists with clinical staff competency validation and education, as needed. Provides clinical consultation, guidance, and oversight related to in-person and telephone triage processes for same-day appointments, and collaborates with a team of triage nurses to support appropriate clinical prioritization and continuity of care. As an integral member of the multidisciplinary team, utilizes the nursing process to support clinical decision-making, care planning, and coordination of services for patients and their families in the outpatient setting, as required. Ensures patient rights to privacy, safety, and confidentiality are maintained. Maintains a safe environment in accordance with established standards, policies, and safety regulations, and ensures compliance with infection control requirements. Engages in complex, independent problem-solving in collaboration with clinical staff and patient care coordinators, including coordination and oversight of patient care activities across multiple practice sites or within a clinic setting. Essential Duties: Follows policies and procedures: demonstrates ability to access online manuals and references Serves as Lead RN and resource to clinical staff. Supervises at least two full-time staff or the equivalent, coordinates personnel actions, including, but not limited to performance evaluations, time-off requests, staff disciplinary actions, hiring, and terminating staff. Serves as a personal contact for physicians, staff, patients and outside departments in order to address problems, issues or concerns that require attention. Trains and competency validates all clinical staff to ensure compliance with hospital policies. Acts as liaison between supervisor and his/her subordinates for communicating information, assignments, priorities and special requests. Monitors status of pending items and follows-up, as needed. Ensures that exam rooms and treatment areas are supplied and maintained adequately by support personnel. Promotes security by alerting appropriate personnel for safety, fire and other unsafe situations. Reports any unusual occurrences to supervisor. Responds to emergency situations using standard emergency protocols and procedures. Participates in monitoring and evaluating the quality and appropriateness of patient care. Contributes objective data regarding performance of other clinical staff members, as requested. Maintains a safe environment in accordance with standards, policies and safety regulations. Ensures compliance with infection control policies. Under the direction of a physician and operating within the scope of practice, triages patient phone calls and provides guidance and direction to inquiries per protocols. Transfers learned scientific knowledge into practical application in applying the nursing process ASSESSMENT Appropriately completes nursing assessment and screening upon patient arrival at each appointment, in case of need. PROFESSIONAL DEVELOPMENT Participates in professional hospital/nursing activities Educational workshops Assist in the development or updating of patient education materials DIAGNOSIS Interprets assessment information and formulates nursing diagnosis PLAN Trains staff to maintain problem list, medication list and allergies list INTERVENTION Administers medications as ordered and completes re-assessments as indicated Completes patient care procedures correctly per policy Delegates tasks based on others’ scope of practice and competency Acts as patient advocate DOCUMENTATION Documentation is complete and correct on all encounters Ensures medication list is current and complete EDUCATION Trains staff to provide patient and family education as needed based on diagnosis or treatment plan Evaluates nursing competencies for all licensed staff. COMMUNICATION Communicates effectively with all members of the healthcare team including the patient and family by: Appropriate patient/family interactions Effectively triages phone calls Utilizing e-mail system Communicates effectively with members of the clinical team. ORGANIZATION Manages time effectively. Able to organize and prioritize responsibilities Assists in overseeing daily clinic operational flow OBSERVES REGULATORY AGENCY REQUIREMENTS: National Patient Safety Goals Uses two patient identifiers Does not use unapproved abbreviations Uses procedural time out Uses appropriate communication between providers Completes medication reconciliation Maintains audible alarms Hazardous waste management Biohazard Medication Sharps HIPPA OSHA requirements (ie. No food or drink in clinical areas) TJC (continuous survey readiness) Critical values are written, read back and shared with appropriate provider Dictated orders are written down, read back for validation, signed, timed and dated Maintains a safe work environment for self and others PROFESSIONAL DEVELOPMENT Participates in professional hospital/nursing activities Educational workshops Assist in the development or updating of patient education materials Bonus Points Professional certification Other: Performs other related duties as assigned. Required Qualifications: Req Bachelor’s Degree Nursing Degree in Nursing (BSN) Req 2 years In outpatient/inpatient clinical practice. 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, including whole blood collection, and apheresis procedures, in accordance with administrative and clinical policies, regulations and procedures. Preferred Qualifications: Pref Experience in outpatient/clinic setting. Pref Advanced Cardiovascular Life Support (ACLS) Healthcare Provider from American Heart Association Required Licenses/Certifications: Req Registered Nurse - RN (CA Board of Registered Nursing) Req Basic Life Support (BLS) Healthcare Provider from American Heart Association 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 $121,680.00 - $200,772.00. 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$144086.htmld 
