Nursing Jobs in Villa Park, CA

Risk Adjustment Coding Specialist II (CST/EST)

$70,000 - $85,000 / year

Risk Adjustment Coding Specialist II (CST/EST) Department: Quality - Risk Adjustment Employment Type: Full Time Location: 1600 Corporate Center Dr., Monterey Park, CA 91754 Reporting To: Liz Francisco Compensation: $70,000 - $85,000 / year Description We are currently seeking a highly motivated Risk Adjustment Coding Specialist to support our Houston market. In this role, you will support risk adjustment efforts by conducting high-volume chart reviews to identify coding gaps, trends, and opportunities for improved accuracy for our providers. You’ll translate your findings into actionable insights, creating and delivering education to providers and practice leaders while navigating complex conversations. Additionally, you’ll track and report on key performance metrics—such as HCC recapture rates, AWVs, and other KPIs, helping drive provider performance and overall program success. We are seeking candidates who have experience with provider education and at least 3-5 years of risk adjustment experience! This position requires travel to provider offices twice a week in the Houston area. 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 Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC) Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, Stay informed about changes in Medicare, Medicaid, and private payer requirements. Provides recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives. Trains, mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work. Provides peer to peer guidance through informal discussion and overread assignments. Supports coder training and orientation as requested by manager. May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I Other duties as assigned Qualifications Required Certification/Licensure: Must possess and maintain AAPC certification, CPC and CRC. At least 3 years of experience in risk adjustment coding and/or billing experience required. At least 1 year of experience with targeted provider education. Reliable transportation/Valid Driver’s License/Must be able to travel up to 75% of work time PC skills and experience using Microsoft applications such as Word, Excel, and Outlook Excellent presentation, verbal and written communication skills, and ability to collaborate Must possess the ability to educate and train provider office staff members Proficiency with healthcare coding software and Electronic Health Records (EHR) systems. You're great for this role if: Strong billing knowledge and/or Certified Professional Biller (CPB) through APPC Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage Strong PowerPoint and public speaking experience Ability to work independently and collaborate in a team setting Experience with Monday.com Experience collaborating with, educating, and presenting to provider teams in a face-to-face setting Environmental Job Requirements and Working Conditions The national target pay range for this role is $70,000 - $85,000 per year. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors. This position is remotely based in the U.S. The home office is located at 1600 Corporate Center Dr. Monterey Park, CA 91754. Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon 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 on the basis of 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.

Clinical Nurse II - ED - Nights - FT - Irvine

UCI Health Irvine, CA

Who We Are UCI Health is one of California’s largest academic health systems and the clinical enterprise of the University of California, Irvine. Established on July 1, 1976, UCI Health has grown into a 1,461-bed health system that includes UCI Health — Orange, UCI Health — Irvine, four Community Network hospitals and a growing network of ambulatory care centers across Orange and Los Angeles counties. As Orange County’s only academic health systems, UCI Health is home to the only National Cancer Institute-designated comprehensive cancer center based in the county, the region’s only American College of Surgeons-verified Level I adult and Level II pediatric trauma center, American College of Emergency Physicians Gold Level 1 Geriatric Emergency Department and a nationally recognized regional burn center verified by the American Burn Association. Powered by UC Irvine, UCI Health serves 5.6 million people across Orange County, western Riverside County and southeast Los Angeles County through excellence in patient care, research and medical education. Your Role on the Team Position Summary The clinical nurse will collaborate with interdisciplinary teams to develop and implement a plan of care for a specific group of assigned patients. Performs professional nursing duties that incorporate the psychomotor and age appropriate cognitive skills of the patient/family/significant other to assess, plan, intervene and advocate for the patient on an ongoing basis throughout the continuum of care. Will evaluate patient outcomes, effectiveness of plan of care, and readiness for discharge and revise plan or make referrals as necessary. Acts as a role model and mentor to a variety of students and nurses new to the unit. Functions as a (PCC) Patient Care Coordinator as requested by the supervisor/manager. Required Qualifications What It Takes to be Successful Preventative management of Assaultive Behavior (PMAB) or CPI training within 30 days of hire Minimum 6 months recent emergency room nursing experience All external candidates must have a Bachelor of Science in Nursing Ability to work variable shifts including evenings, nights, weekends, and holidays Ability to read, write and communicate effectively in English Ability to maintain flexibility and work well in a fast paced, constantly changing environment Ability to maintain a work pace appropriate to the workload Preferred Qualifications Understanding of applicable regulatory requirements Prior ICU Nurse experience Bilingual skills to communicate effectively with patients and families Licenses And Certifications Registered Nurse Pediatric Advanced Life Supp Basic Life Support Advanced Cardiac Life Support Education Bachelor of Science, Nursing Total Rewards We offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks. Please utilize the links listed here to learn more about our compensation practices and benefits. Conditions Of Employment The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment: Background Check and Live Scan Employment Misconduct* Legal Right to Work in the United States Vaccination Policies Smoking and Tobacco Policy Drug Free Environment Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer. The following additional conditions may apply, some of which are dependent upon business unit or job specific requirements. California Child Abuse and Neglect Reporting Act E-Verify Pre-Placement Health Evaluation Details of each policy may be reviewed by visiting the following page: https://hr.uci.edu/new-hire/conditions-of-employment.php Closing Statement The University of California 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, disability, age, protected veteran status, or other protected categories covered by the UC Anti-Discrimination Policy. We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable, and welcoming. UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact UCI's Employee Experience Center (EEC) at eec@uci.edu or at (949) 824-0500, Monday - Friday from 8:30 a.m. - 5:00 p.m. Consideration for Work Authorization Sponsorship Must be able to provide proof of work authorization