Nursing Jobs in Sierra Madre, 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) 
$185,000 - $223,000 / year
Job Summary The Clinical Nurse Manager – Ambulatory Surgery Center (ASC), Pre-Admission Testing (PAT), GI Lab, and Central Scheduling is responsible for the operational, clinical, regulatory, and financial performance of these perioperative support and procedural areas. Reporting to the Director of Perioperative Services, the Manager provides leadership to ensure safe, high-quality, efficient patient care delivery across ambulatory procedural services and perioperative preparation workflows. The Manager oversees daily operations, staffing, regulatory compliance, patient throughput, scheduling processes, quality improvement initiatives, and staff engagement while fostering a culture of accountability, collaboration, and service excellence. This role collaborates closely with surgeons, anesthesia providers, nursing leadership, and scheduling teams to optimize procedural access, improve patient preparedness for surgery, and ensure efficient coordination of care throughout the perioperative continuum. Major Responsibilities / Essential Functions Clinical Operations & Procedural Oversight (25%) • Manages day-to-day operations of ASC, PAT, GI Lab, and Central Scheduling. • Ensures delivery of safe, evidence-based care in procedural environments. • Coordinates patient preparation, procedural flow, recovery processes, and scheduling operations. • Monitors patient safety indicators and clinical outcomes in ambulatory procedural settings. Patient Throughput & Scheduling Coordination (20%) • Oversees Central Scheduling operations to ensure efficient surgical and procedural scheduling. • Coordinates scheduling workflows with surgeons, physician offices, and perioperative departments. • Monitors scheduling accuracy, case readiness, and patient preparation timelines. • Works with PAT to reduce day-of-surgery cancellations and delays. Quality Improvement & Regulatory Compliance (15%) • Maintains regulatory readiness for Joint Commission, CMS, and CDPH requirements. • Ensures compliance with infection prevention, patient identification, and procedural safety standards. • Monitors quality indicators including same-day procedure cancellations and patient preparation compliance. • Leads performance improvement initiatives based on quality and operational metrics. Workforce Leadership & Staff Development (20%) • Manages hiring, onboarding, performance evaluations, and corrective action processes. • Develops staffing plans aligned with procedural volume and patient acuity. • Ensures competency validation for nurses and procedural staff. • Promotes professional development and certification attainment. Financial Stewardship & Resource Management (10%) • Assists in development and monitoring of departmental budgets. • Monitors productivity, staffing utilization, overtime, and premium pay. • Supports supply management and cost containment initiatives. Interdisciplinary Collaboration & Physician Partnership (10%) • Collaborates with surgeons, gastroenterologists, anesthesia providers, and physician offices. • Facilitates communication between procedural departments and surgical services. Job Qualifications Minimum Education • Bachelor of Science in Nursing (BSN) required. Preferred Education • Master’s degree in Nursing, Healthcare Administration, Business Administration, or related field preferred. Minimum Experience • Minimum 3–5 years acute care nursing experience. • Minimum 2–3 years nursing leadership experience. • Experience in perioperative services, ambulatory surgery, procedural services, or GI/endoscopy required. Required Licensure & Certifications • Current California Registered Nurse (RN) License • Basic Life Support (BLS) – American Heart Association • Advanced Cardiac Life Support (ACLS) – American Heart Association • NE-BC (Nurse Executive – Board Certified) required within 12 months of hire • CNOR, CGRN, CAPA, or CPAN certification preferred • Los Angeles County Fire Card within 30 days of hire • Assault Response Competency (ARC) within 30 days of hire Compliance, Service & Safety Consistently supports compliance with the organization’s Code of Conduct, maintains confidentiality of information, protects organizational assets, and adheres to all federal, state, and local regulatory requirements. Managers are accountable for communication, implementation, monitoring, and enforcement of compliance policies within their departments while promoting a safe and respectful work environment. Full-Time, Exempt 