Nursing Jobs in Tustin, 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. 
$127,357.12 - $157,289.14 / year
Telecare's mission is to deliver excellent and effective behavioral health services that engage individuals in recovering their health, hopes, and dreams. Telecare continues to advance cultural diversity, humility, equity, and inclusion at all levels of our organization by hiring mental health peers, BIPOC, LGBTQIA+, veterans, and all belief systems. As a part of the Telecare Family, La Paz is a 148 bed Gero-Psychiatric center which serves adults 55 and older. Full Time; AM 8:00 am - 4:30 pm; Days vary as needed and/or based on work availability Expected starting wage range is $$127,357.12 - $157,289.14. Telecare applies geographic differentials to its pay ranges. The pay range assigned to this role will be based on the geographic location from which the role is performed. Starting pay is commensurate with relevant experience above the minimum requirements. POSITION SUMMARY The Director of Nursing (DON) is responsible for activities and functions related to the administration of member care systems and member care in nursing areas and departments. ESSENTIAL FUNCTIONS • Demonstrates the Telecare mission, purpose, values and beliefs in everyday language and contact with internal and external stakeholders. • Plans, organizes, directs and controls nursing services • Develops departmental goals, objectives, standards of performance, policies and procedures; organizes the department to meet legal, organizational and medical staff guidelines; functions in an advisory capacity to the Administrator in evaluating procedural changes as they relate to care of members served • Makes use of management practices that include empowerment of staff, the provision of clear and concise expectations regarding duties assigned employees, frequent feedback focusing on both positive and problematic aspects of work performance, and other management practices that are consistent with Continuous Quality Improvement • Promotes and maintains professional and effective relationships and communications within the department and with other departments • Collaborates with other administrative staff in strategic planning activities with the goal of ensuring ongoing effectiveness of the facility • Is available to assist at other Telecare facilities, which may involve travel • Establishes staffing requirements and recommends to administration the numbers and classifications of personnel to be employed • Directs the recruitment, selection and when necessary disciplinary action within the Nursing Department • Implements the safety program and actively participates in reducing Workers Compensation • Establishes standards for procurement of supplies and equipment for the department • Manages the Nursing Department within allocated budgetary parameters and participates in the development of the fiscal budget • Ensures that the nursing department is in compliance with all related state, federal and local licensing regulations and requirements • Oversees and ensures medication management and infection control standards • Collaborates with leadership team and all department on quality initiatives • Coordinates nursing services with other clinical and ancillary services. In the process of accomplishing this, promotes the cost-effective use of personnel, supplies and equipment • Participates and encourages participation from staff in activities, including professional and trade organizations, that promote mental health services • Establishes and defines standards which ensure safe and therapeutically effective care • Assesses the quality of care rendered by the Nursing Department and ensures sound practice • Establishes and maintains a comprehensive Quality Assurance/Quality Improvement program within the Nursing Department which includes frequent collaboration with other departments, employee education, and a focus on monitoring departmental standards and actively removing barriers to the provision of high quality care • Is an active participant of all committees involving members served safety, nursing policies, practices and procedures • Assumes responsibility for her/his professional growth and the ongoing professional development of the nursing staff • Must assist with restraint of members served in the event of assaultive behavior and pass assault crisis/crisis prevention training. Duties and responsibilities may be added, deleted and/or changed at the discretion of management. QUALIFICATIONS Required: • Must be a graduate of an accredited school of nursing and have four (4) years of experience - two (2) in psychiatric nursing and two (2) years in a supervisory capacity; OR a baccalaureate degree in nursing or a related field and two (2) years of experience and one (1) year in a supervisory capacity • Current valid licensure as an RN in the state CA • Skilled Nursing Facility experience required • Must be CPR, Crisis Prevention Institute (CPI), and First Aid certified on date of employment or within 60 days of employment and maintain current certification throughout employment • All opportunities at Telecare are contingent upon successful completion and receipt of acceptable results of the applicable post-offer physical examination, 2-step PPD test for tuberculosis, acceptable criminal background clearances, excluded party sanctions, and degree or license verification. If the position requires driving, valid driver’s license, a motor vehicle clearance, and proof of auto insurance is required at time of employment and must be maintained throughout employment. Additional regulatory, contractual, or local requirements may apply. Preferred: • Administrative experience in long term care SKILLS • Excellent communication • Attention to detail • Critical thinking to aid decision-making • Flexibility and ability to adapt • Commitment to development PHYSICAL DEMANDS The physical demands here are representative of those that must be met by an employee to successfully perform the essential functions of this job. The employee is occasionally required to stand, twist, squat, kneel and lift and carry items weighing 25 pounds or less as well as to frequently sit, walk, reach, bend and do simple and firm grasping. The position requires manual deviation, repetition and dexterity and to occasionally drive. EOE AA M/F/V/Disability If job posting references any sign-on bonus internal applicants and applicants employed with Telecare in the previous 12 months would not be eligible. 
