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Salary Range:&nbsp;&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)PLEASE NOTE:&nbsp; This position will work&nbsp;Tuesday - Saturday, 7 a.m. to 4 p.m. PST, with rotating holidays.&nbsp; At this time, we are only considering those candidates that live in the Pacific Time Zone.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.<h4>Job Summary</h4> The Customer Solution Center Appeals and Grievances (A&amp;G) Nurse Specialist Registered Nurse (RN) II provides direct assistance to member's with health care access or benefit coordination issues, ensuring that clinical grievances, complaints and complex issues are investigated and resolved to the member's satisfaction in a manner consistent with L.A. Care, Centers of Medicare and Medicaid Services (CMS) and regulatory guidelines. Benefit coordination may involve coordinating multiple L.A. Care products, Fee for services (FFS )Medi-Cal/Medicare, or commercial insurance.&nbsp;<h4>Duties</h4>Conducts intake/triage and appropriate classification of Clinical A&amp;G, and Pharmacy requests and makes accurate judgment on appeal, grievance, Provider Claim Disputes, medical records or other issues and follows procedures on how to handle each type of request and route to the appropriate area within the department.Investigation, and resolution of clinical member complaints (grievances/appeals) utilizing all regulatory requirements.&nbsp; Investigation, and resolution of clinical Provider Complaints/ Provider Data Resolution (PDR) (grievances/appeals) utilizing regulatory and internal guidelines and Service Level Agreement (SLA). Identification of Expedited Cases and resolution within 72 hours.Works with the external providers and Participating Physician Group's (PPG) representatives to obtain relevant medical records and communication documentation.Prepares resolved complaint files for Centers for Medicare and Medicaid Services (CMS), DMHC, and external review organization (QIO or IRE).&nbsp; Process the case thru to effectuation and final case documentation in the A&amp;G system of record.Investigation and preparation of State Fair Hearing cases as assigned. Prepares resolved complaint files for CMS external review organization - Quality Improvement Organization (QIO) or Independent Review Entity (IRE).Conducts reviews and presents to physicians, provider disputes which would be based on medical necessity reviews. Prepares authorizations, after approval by the Medical Director.When necessary, outreaches to providers, vendors, hospitals, and members to request necessary information or to provide case status and/or next steps.&nbsp; In instances where necessary, sends written notifications to appropriate parties. All interactions including verbal outreach and written communication will be documented in the A&amp;G system of record. Participates inter-rater reliability training and assessments.<h4>Perform other duties as assigned.</h4><h4>Duties Continued</h4><h4>Education Required</h4>Associate's Degree in Nursing<h4>Education Preferred</h4>Bachelor's Degree in Nursing<h4>Experience</h4>Required:At least 5 years of experience in Clinical Nursing and 2 years in Medicare/ Medicaid in a managed care/ health plan environment. <h4>Skills</h4> Required:Excellent interpersonal and communication skills. Computer literacy and adaptability to computer learning. Time management and priority setting skills.Must be organized and a team player Able to work effectively with various internal departments/service areas, L.A. Care's plan partners, participating provider groups, and other external agencies.Good working knowledge of regulatory requirements/standards.<h4>Licenses/Certifications Required</h4>Registered Nurse (RN) - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4>This position requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical situations and work on-call.This position requires handling various caseloads and flexibility to adapt to changing priorities which may include but not limited to redistributed work assignments, team projects, and other priorities as assignedSalary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.L.A. Care offers&nbsp;a wide range of benefits including<ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul>

L.A. Care Health Plan

Customer Solution Center Appeals and Grievances Nurse Specialist RN II

The Residential Rehabilitation Educator position is a great opportunity to work in the Human Services field.&nbsp; In this program, adults with mental illness share a home in the community.&nbsp; Our residential staff supports them to reach their goals by teaching them daily living skills to move them toward independence, assist in management of their psychiatric symptoms, ensure their physical health, and improve their quality of life!Join our team and play an essential role in enabling adults with mental illness to live as actively and independently as possible!Responsibilities include:<ul><li>Teaching daily living skills such as cooking, budgeting, and social skills</li><li>Implementing treatment plans that assist with reaching goals or symptom management</li><li>Administering medications</li><li>Transporting to doctor's appointments and social activities</li><li>Using an electronic health record system for client notes</li></ul>We offer a competitive salary and a great benefit package!<ul><li>Tuition remission program - 100% tuition for undergraduate coursework in a Massachusetts State College or University</li><li>Health/dental insurance</li><li>Generous paid time off</li><li>Various opportunities for career advancement</li><li>Commitment to provide quality training to our staff</li><li>Group discounts on cell phones, movie tickets and various club memberships</li><li>Company contributions to retirement plan</li><li>Company paid life insurance</li><li>Opportunities to attend in-service trainings and more…</li></ul> <h4>Required Skills</h4><ul><li>Patience and an understanding and ability to interact with individuals with disabilities</li><li>Dependability, flexibility, and desire to help others</li><li>Computer proficiency and ability to learn to use an electronic health record system</li><li>Must have a valid driver’s license and safe driving record---access to a personal vehicle required at some sites</li></ul> <h4>Required Experience</h4><ul><li>Previous experience working in the human services field, or completed coursework in Psychology, Social Work, or related field</li><li>CPR/FA and MAP certification will be required</li><li>BA/BS in Psychology or related field preferred</li></ul>Aspire Health Alliance is committed to and passionate about diversity, equity, and inclusion. &nbsp;We celebrate, support and promote diversity of thought, culture, and backgrounds.&nbsp; As an employer committed to equal opportunity, we base all employment decisions on each individual’s capabilities and qualifications, without regard to race, color, religious creed, national origin, ancestry, sex, sexual orientation, gender identity, age, physical or mental disability, veteran status, genetics, or any other protected characteristic.&nbsp; Aspire Health Alliance strives to fully reflect the clients and communities we serve and believes that a diversity of interests and cultures leads to a stronger and more innovative organization.

Aspire Health Alliance

Residential Counselor/Overnight, $17.50, Sun-Wed, 11p-9a, $2000 Sign On Bonus!

<h4>How you'll change lives</h4>As a Registered Nurse (RN) at US Renal Care, you'll be an integral part of a cross-functional team, working under the supervision of a Charge Nurse and assisting and supervising Patient Care Technicians (PCTs) to care for patients living with kidney disease.<h4>What you'll be doing</h4>Patient care. You'll work directly with patients to provide safe, comfortable, and high-quality dialysis treatment. Responsibilities include completing and documenting physical assessments before and after treatments and monitoring patients during treatment. You'll ensure quality renal care by completing monthly reviews of patient medication profiles and administering medications according to physician orders. Teamwork. You'll be a critical member of an interdisciplinary team to provide all required patient assessment and care planning activities. You'll also make sure center staffing requirements are met at all times under the direction of the Administrator and according to state regulations for staffing ratios.Safety &amp; Quality. Working under the supervision of a Charge Nurse, you'll adhere to all company policies and procedures and state and federal laws and regulations. You'll participate in all required staff meetings and continuing education offerings.

U.S. Renal Care

Dialysis Registered Nurse - Hilo Acutes

Dialysis Bilingual-Spanish Registered Nurse - RN Chronic In-center

The RN Charge Nurse is responsible for overseeing nursing services each shift and functions as a nursing supervisor. This position provides daily supervision of staff on duty during operational hours.Essential Duties and Responsibilities include the following. Other duties and tasks may be assigned.<ul><li> Assist with clinical and operational processes to improve patient health and minimize hospitalizations and missed treatments.</li><li> Demonstrate effective use of supplies and staff labor hours.</li><li> Complete and document monthly review of patient medication profiles. Administer medications as ordered by the physician.</li><li> Assist physician during patient rounds and transcribe and implement physician orders timely.</li><li> Assist with the implementation of anemia management and medication protocols as requested.</li><li> Knowledge of and comply with federal, state, local laws and regulations, including health care professionals practice act requirements.</li><li> Perform duties at all times within limitations established by and in accordance with company policy and procedures, applicable state and federal laws and regulations.</li><li> May give direct patient care to the extent of performing efficient, safe dialysis, if allowed by state regulations.</li><li> Responds to all emergencies in clinic.</li><li> Communicate results of patient assessment, reassessment, and ongoing monitoring to the physician, team members, and others as appropriate to the individual needs of the patient.</li><li> Maintain collaborative working relationship with Medical Director and physicians.</li><li> Participate as a member of the Interdisciplinary team in all required patient assessment and care planning activities.</li><li> Assist in orientation of new staff as a preceptor or in assigning a preceptor.</li><li> Acts as resource person and participates in implementing and evaluating dialysis services and assures that policies and procedures are updated.</li><li>Assists Administrator in interviewing, hiring, evaluating, and disciplinary actions of center staff</li></ul>

Dialysis Charge Nurse - RN Chronic In-center

Dialysis Registered Nurse

About us:Navvis is a leading population health company, driving performance in value-based care. As an operating partner to some of the country’s most innovative health systems, physician enterprises, and health plans, we provide solutions that accelerate the journey to value-based care. Our approach is market-based – we respect the unique needs of populations in each community, including access to care, culture, values, and capabilities. Together with our partners, we set a new national standard in healthcare performance that delivers the affordability, quality, access, and experience that all patients deserve.Department overview:What if we routinely asked every person involved in providing or receiving care: "What matters to you and why?" How would understanding "what matters" enhance our ability to transform health in communities and strengthen the connective process, leading to deeper levels of interaction and integration? The Post-Acute team is a part of our larger Throughput team, where we are deeply passionate about understanding what matters to people to ensure the delivery of Real-Person Care. We create an ecosystem that builds a foundation for better physical, social, and emotional health. Our Care Solutions, Analytics, Implementations, Clinical and Business Operations, and Learning and Development teams work tirelessly in partnership with our clients and stakeholders in communities to address the real-life healthcare needs people have every day.This role is based in the Boston region, working with Tufts Medicine.As the Director, RN – Post-Acute and Home Health (Tufts), you will:<ul><li>Regularly review performance of Post-Acute Care Alliance members through quarterly scorecards (if applicable), ACO expenditure reports, claims data, and other reporting methods as available to understand each facility’s overall performance (including value-based payment models and other risk-based contracts).</li><li>Review referral acceptance rates, denials and admissions to non-alliance members for trend analysis and improvement opportunities.</li><li>Collaborate with VP, Care Continuum to achieve efficient communication across the continuum.</li><li>Meet with each transitional care unit/skilled nursing facility in the PAC alliance, to create regular channels of interaction, communicate changes, review performance, and understand opportunities for improvement. Ensure mutually determined goals are on track for achievement.</li><li>Identify performance gaps in the alliance overall, as well as at an individual facility level, and develop strategies with corresponding action plans to improve performance.</li><li>Lead a team of Post-Acute Care associates supporting patients in the transitional care unit/skilled nursing facility and post-acute care programs to ensure proactive discharge planning and coordinated care management. Assist in complex case planning and collaboration. Escalate performance concerns with facilities as indicated.</li><li>Ensure collaboration between PAC associates and other stakeholders for a streamlined process that allows for the most efficient management of patients.</li><li>Work across transitional care unit (TCU)/skilled nursing facility (SNF), home health partners, and internal stakeholders to advance clinical capabilities in the TCU/SNF Alliance, to care for an increasingly complex patient mix.</li><li>Work with internal Navvis and key client teams to ensure inpatient rehabilitation facilities and home health network are adequately serving the needs of the population.</li><li>Collaborate with other key Navvis teams to ensure a coordinated approach to care delivery. Including meeting regularly with appropriate stakeholders that intersect with post-acute and Care at Home performance, such as hospital care management, ambulatory care management, value-based care programs leads, health plans, geriatric programs, etc. to relay SNF Alliance and Care at Home performance to ensure the optimization of outcomes.</li><li>Annually, and as indicated, review overall alliance composition related to performance and collaboration. Provide recommendations for changes to the alliance membership as indicated.</li><li>Provide regular report-outs to internal and external teams to allow visibility into post-acute and Care at Home performance.</li><li>Participate in national PAC and Care at Home administrative meetings on a quarterly basis to collaborate and share best practices.</li><li>Other duties as required.</li><li>Travels up to 80% to facilities and locations within the Boston market</li></ul>A day in the life:<ul><li>As part of the Navvis Boston market Throughput and Post Acute team, you will play an instrumental role in building collaborative workflows to optimize the quality and continuity of-care patients receive post-discharge.</li><li>Working closely with aligned Post-Acute Care and Care at Home providers, the In-Market Post Acute and Care at Home Administrator will drive higher levels of performance with Post Acute and Care at Home partners through quarterly provider performance scorecard review sessions, problem solving, referral processes, ongoing action planning, and tracking.</li><li>The Administrator will also participate in briefings and education sessions with a variety of stakeholders within the local health system, as well as within alliance facilities.</li></ul>What success looks like in this role:<ul><li>Develop relationships with key internal and external stakeholders to collaborate and advance plans to improve on mutually established KPIs.</li><li>Maintain an understanding of current regulatory and market operational challenges that may impact performance.</li><li>Assist and/or lead in alliance development.</li><li>Bring Post-Acute and Care at Home best practices related to value-based care integration.</li></ul>RequirementsWe are excited about you if you have these things:<ul><li>Bachelor’s degree in nursing, with Registered Nurse (RN) licensure for Massachusetts</li><li>5 years of strategy, operational or clinical leadership in the post-acute industry</li><li>Experience in operations or leadership within Care at Home or Home Health setting</li><li>Demonstrated history of developing and implementing data-based performance improvement strategies</li><li>An understanding of healthcare economics and regulatory requirements governing skilled nursing/home health, BPCI A, MSSP/ACOs, CMS Waiver Programs, etc.</li><li>Organizational skills, with an ability to prioritize multiple requests and deadlines</li><li>Strong leadership and communications skills to achieve buy-in and collaboration toward objectives</li><li>Experience with Microsoft Office, Word, PowerPoint, Excel and Teams, plus other virtual conferencing platforms</li><li>Must be in the Boston, MA area</li></ul>What you'll get:Navvis is committed to attracting the most insightful and motivated talent by providing a candidate and onboarding experience that you won't find elsewhere! We foster an environment and culture that allow people to be creative, feel connected and be inspired to do their best work no matter where they are on the map. For all colleagues at Navvis, we strive to ensure that they have everything needed to be successful. From the basics like a competitive total rewards strategy, volunteering and social engagement activities to creating company experiences that challenge you to think differently and do different things as part of our never stop learning ecosystem, we support the whole person when you become a team member at Navvis.Navvis offers a competitive benefits package including, but not limited to, medical, dental, vision,with a safe harbor contribution and Paid Time Off plan starting at 2+ weeks.Our commitment:Navvis is an equal employment opportunity and affirmative action employer seeking diversity in qualified applicants for employment. All applicants will receive consideration for employment without regard to race, ethnicity, color, gender, gender identity, age, religion, creed, national origin, ancestry, disability, perceived disability, medical condition, genetic information, military or veteran status, sexual orientation, or any other protected status, as defined by applicable law. Prior to the next step in the recruiting process, we welcome you to inform us confidentially if you may require any special accommodation to complete your application and participate fully in our recruitment experience. Contact us at <a href="mailto:H.R@navvishealthcare.com" target="_blank">H.R@navvishealthcare.com</a>.

NAVVIS

Director, RN - Post-Acute and Home Health (Tufts)

Job Title: Resource Counselor POSITION SUMMARY: The Resource Counselor will work in the H.G. Lewis Campus School and responds to crisis, by assisting with behavior management support and responds when a Teacher needs a student removed from class. Provides supervision to students throughout the school day when necessary. New Directions is an equal opportunity employer committed to championing the principles of anti-racism, justice, and equity. We welcome prospective employees from diverse cultures and backgrounds, for all positions, who will uphold our values and contribute to our mission. We aim to have a leadership and workforce that is reflective of the communities we work in partnership with. Pay and benefits <ul><li>Over 3 weeks of paid time off 1st year with the agency.</li><li>Access to affordable life, dental and medical insurance.</li><li>401k with up to 3% agency matching.</li><li>$18.00 - $19.85/hr to start. Additional raises guaranteed.</li><li>Consistent schedule Monday - Friday, 7:30a - 2:30p schedule.</li><li>Join our company, where over 30% of our staff have been with us for 10 years or more.</li></ul> Minimum Education and/or Professional Qualifications/Skills <ul><li>High School diploma or equivalent.</li><li>Previous experience with children with behavior disorders preferred.</li></ul> We want to emphasize that the preferred qualifications are not required and that we are committed to helping our future colleagues develop these preferred skills. We strongly encourage those who are passionate about fostering a diverse, inclusive and equitable human service organization to apply. Job Title: Resource Counselor Department: HGLCS Title of Immediate Supervisor: Resource Counselor Supervisor POSITION SUMMARY: Responds to crisis by assisting with behavior management support and responds when a Teacher needs a student removed from class. Provides supervision to students throughout the school day when necessary. RESPONSIBILITIES/DUTIES: 1. Responds to a crisis by assisting with behavior management support and when a Teacher needs a student removed from class. 2. Supervises students removed from the Campus School until the student is able to return to the program. 3. During the regular school day, supervises students suspended from the public schools until the student is able to return to school. 4. Provides supervision in hallways or lunchroom when necessary. 5. Supervises in-school suspension. 6. Performs related duties as requested by the Principal. 7. Walks through the classrooms and hallways at the change of classes. 8. Checks-in all Campus School day students every morning and checks-in residents when they are returning late from a home visit during the school day. 9. Assists teachers in de-escalating students when in crisis. 10. Supervises extended time outs when requested. 11. Supervises day students as they wait for p.m. buses. 12. Staff training of TCI when requested by the Principal. 13. Keeps records of “out-of-program” students and makes disciplinary suggestions pertaining to these students. 14. When requested by the Principal, prepares reports on “out-of-programs”, in-school suspensions and time-outs. 15. Supports Campus School wide PBIS Program. 16. Maintains Therapeutic Crisis Intervention and First Aid/CPR certification provided by the agency. 17. Attends all mandatory in-service training and regularly attends supervision meetings. 18. Any additional duties assigned by immediate supervisor. SKILL, QUALIFICATIONS, KNOWLEDGE, ABILITY &amp; PHYSICAL REQUIREMENTS: Minimum Education and/or Professional Qualifications/Skills High School diploma or equivalent. Previous experience with children with behavior disorders preferred. Special – Personal Skills, Qualities, Aptitudes and Physical Requirements New Directions Youth &amp; Family Services, Inc. is an equal opportunity employer. Reasonable accommodations may be made to enable persons with disabilities to perform essential functions. 1. Ability to work effectively with youth, families, staff and community contacts from a variety of cultural and ethnic backgrounds. 2. Ability to deal effectively with hostile youth and/or families. 3. Ability to accept supervision and perform as part of a team. 4. Ability to be flexible and adapt to change. 5. Ability to interface with people (groups and individuals) and communicate within various mediums (logbooks, E-mail, telephone). 6. Must have a valid driver’s license, adequate auto insurance and meet the criteria for driving set forth in the New Directions Driver’s License policy and Auto Insurance policy. 7. Ability to pass annual physical for Category 3 job classification in accordance with New Directions Employee Health policy. 8. Must comply with Agency safety standards and be responsible for own actions and conduct concerning safety and healthy working conditions.

582 Social Services / Nursing Jobs