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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>

U.S. Renal Care

Dialysis Registered Nurse - Charge | MWF

Salary Range:&nbsp;&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(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. <h4>Job Summary</h4>The Facility Site Review (FSR) Nurse Specialist RN II conducts Full Scope Reviews, Site Review Surveys, Medical Record Review Surveys, Specialty Site Review Surveys, physical accessibility review survey (PARS) assessments, Focused Reviews, Interim Onsite Reviews, Consultation/Educational Site visits, Investigative visits, and/or other appropriate site visits to ensure quality FSR and physician compliance with Local, State, and Federal requirements.&nbsp; The FSR Nurse Specialist RN II may also conduct face-to-face visits with our high-membership physicians to provide feedback, data, and education on programs and facilitates changes to improve quality of care and service to members.<h4>Duties</h4>Conducts audits utilizing Department of Health Care Services (DHCS) FSR/MRR/PARS tools.&nbsp; Provides pre-audit and /or post audit educational sessions. Issue Corrective Action Plans (CAPs) and provide assistance or follow up in implementing adequate correction(s) on-site. Gives providers health education materials and clinical tools to facilitate improved screening, preventive care, and chronic disease management; promote clinical quality improvements in practices.Acts as the Provider Quality Improvement Liaison (PQIL) to assess and communicate issues and improvement opportunities identified during the physician site visit.Communicates and coordinates information and findings from site visits between FSR Manager, internal and external staff and provider sites.&nbsp; Documents discussions and correspondence in FSR file as appropriate.Assists and participates in the Annual Audit of Plan Partners delegated for FSR.Perform other duties as assigned.<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 clinical experience including, but not limited to Emergency Room (ER)/Acute care nursing or outpatient setting.Preferred:&nbsp; Medi-Cal managed-care auditing experience.At least one (1) year experience in Quality Improvement and/or familiar with DHCS audit tool.<h4>Skills</h4>Required: Excellent verbal and written communication skills.Excellent organizational and time-management skills.Proficient in Microsoft Office.<h4>Licenses/Certifications Required</h4>Registered Nurse (RN) - Active, current and unrestricted California LicenseMust obtain and maintain successful completion of a DHCS Certified Site Reviewer certification in order to conduct DHCS accepted audits independently within 8 months of date of hire in the position.<h4>Licenses/Certifications Preferred</h4>Department of Health Care Services (DHCS) Certified Site Reviewer<h4>Required Training</h4>1:1 on-site and/or virtual training with Certified Site Reviewers (CSRs) until certification is obtained. Minimum of 8 months.&nbsp; <h4>Physical Requirements</h4>Light<h4>Additional Information</h4>Required:Travel to offsite locations for work.Travel is required 80% of time.Salary 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> Nearest Major Market: Los Angeles Job Segment: Nursing, Registered Nurse, Travel Nurse, Emergency Medicine, Healthcare

L.A. Care Health Plan

Facility Site Review Nurse Specialist RN II

<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.

Dialysis Registered Nurse | Part Time

Job Description:Position Summary:Reporting to the Associate Director of Student Support Services - Student Advising, Student Support Counselors (SSC) are the single-point of access for students and provides student-centered support services. SSCs administer a high-level of student service to ensure retention, student satisfaction, and success of students. SSCs are responsible for adhering to all internal, federal, Department of Education, and affiliate policies and procedures. Student contact is extensive and substantive as is maintaining accurate records in order to support students’ through their programs. Staff members are expected to exercise a high degree of responsibility and independent judgment, and to work hours consistent with the campus student populations’ need for access to services.About the Department:The Student Support Services team is the single-point of access for students and provides student-centered support services. SSCs administers a high-level of customer service to ensure student persistence and success.Student Support Services team members work collaboratively within the office and with many other campus-wide constituent groups. Team members are expected to exercise a high degree of responsibility and independent judgment, and to work hours consistent with the campus student populations’ need for access to services (necessitating regular evening and weekend hours).Principal Duties:<ul><li>Work with and support new and continuing students at various stages of their education.</li><li>Administer advising services including registration, evaluation of program requirements, incomplete grades, student class activity, Satisfactory Academic Progress, and overall degree progress.</li><li>Call/meet with each student throughout the term to ensure they are successfully completing coursework and to provide support.</li><li>Respond to calls and e-mails from incoming or current students on a daily basis by providing guidance regarding course work, policies, and support.</li><li>Ensure students' academic accounts/records are accurate and up-to-date by clear and timely processing of important academic forms (e.g. Add/Drop, Withdrawal, Leave of Absence, etc.).</li><li>Advise at-risk students through work/life balance, time management, and other circumstances to ensure successful completion of the course and program.</li><li>Advise students on course/program content and registration in degree program of study.</li><li>Provide tracking and follow-up on the progress of&nbsp;Academic Plans for students who do not meet the Satisfactory Academic Progress requirements or who are in need of additional support.</li><li>Collaborate with various student-facing departments such as Academics, Financial Aid, Admissions, and Student Accounts to ensure the success of the student.</li><li>Work with Office of the Registrar to ensure that incoming and current students receive timely information and guidance regarding institutional policies, course registration, program completion, etc.</li><li>Advise students on support services and resources available to them through their school.</li><li>Adhere to set internal, federal, DOE, and affiliate policies and procedures, integrity and ethical standards.</li><li>Perform other duties as assigned.</li></ul>Essential Knowledge, Skills, and Abilities:<ul><li>Excellent PC skills (Word, Excel, Power Point) and other clerical skills (phone skills, typing, filing)</li><li>Skills to establish and maintain effective relationships</li><li>Excellent verbal and written communication skills</li><li>Organizational and time management skills</li><li>Ability to collaborate and communicate with all students regardless of educational level as well as all employees regardless of position, title, or location</li><li>Excellent team work</li></ul>Position Qualifications:<ul><li>Bachelor's degree required</li><li>Experience within student facing positions and/or higher education preferred</li><li>Ability to work weekends and evenings</li></ul>Compensation &amp; BenefitsThis opportunity is budgeted at $$&nbsp;21.79-25.64. base compensation. Additional compensation factors may impact total compensation. To learn more about our competitive benefits and additional rewards, including generous paid time-off, medical and dental insurance coverage, life and disability insurance, retirement plan with employer contribution, multiple flexible spending accounts, tuition reimbursement, click the link below.<a href="https://www.thechicagoschool.edu/career-opportunities/" target="_blank">https://www.thechicagoschool.edu/career-opportunities/</a>The Chicago School is an Equal Opportunity Employer.Please note: For the protection of faculty, staff, students, and all who enter our facilities, The Chicago School strongly recommends that all employees are fully vaccinated for COVID-19 per CDC guidance.

The Chicago School of Professional Psychology

Student Support Counselor

Dialysis Registered Nurse

Job Description:POSITION SUMMARY:The Enrollment Counselor position at Pacific Oaks supports all recruitment, admissions, and advising efforts at the college. Additionally, it helps with activities by handling communications, information and paper flow with prospective and admitted students. The successful candidate will be an articulate, organized, results driven, a dynamic and enthusiastic leader, and a team player.This position is located in Pasadena and reports directly to the Director of Admissions.SUPERVISION RECEIVED:The incumbent performs a variety of routine work within established policies and procedures and receives detailed instructions on new projects and assignments.ESSENTIAL FUNCTIONS:Customer Service &amp; Communication<ul><li>Provide excellent customer service to prospective students throughout the full admissions recruitment process.</li><li>Counsel prospective students on completing Admissions requirements, academic programs, admission options, financial aid opportunities, and campus tours.</li><li>Assist new and continuing students with the registration process.</li><li>Conduct follow-up with prospects and applicants through phone and written correspondence.</li></ul>Admissions Goals &amp; Outreach<ul><li>Meet daily expectations for outbound calls and setting campus consultations.</li><li>Meet or exceed Admissions benchmark goals.</li><li>Plan and coordinate on-campus Information Sessions and Open Houses for prospective students.</li></ul>Team Collaboration &amp; Meetings<ul><li>Regularly attend department staff meetings.</li><li>Liaise with corresponding departments to support the admissions team.</li><li>Ensure students meet with Faculty Advisors to outline program completion plans.</li></ul>Administrative &amp; Data Management<ul><li>Track and document all communications with inquiries, applicants, and students using Salesforce and Campus Vue.</li><li>Ensure accurate record-keeping for all recruitment activities.</li></ul>Flexibility &amp; Availability<ul><li>Be available to work evening shifts and rotating Saturday shifts as needed to support recruitment efforts.</li></ul>Diversity &amp; Inclusion<ul><li>Contribute to a work environment that values diversity, fosters respect, and promotes skills to engage with individuals from various cultures and backgrounds.</li></ul>Other Duties<ul><li>Perform additional duties as assigned to support the Admissions Office and the institution.</li></ul>Is regular attendance an essential function?&nbsp; ☒ Yes&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ NoESSENTIAL KNOWLEDGE, SKILLS and ABILITIES:Knowledge:<ul><li>Program Knowledge: Familiarity with CFP, HD, SOE programs, and state licensure requirements.</li></ul>Skills:<ul><li>Consultative Approach: Skilled in addressing concerns and assisting with enrollment decisions.</li><li>Communication Skills: Excellent written and verbal communication.</li></ul>Abilities:<ul><li>Goal-Oriented: Accountable for meeting monthly goals and performance expectations.</li><li>Relationship Building: Effective in establishing rapport with prospective students.</li><li>Time Management: Strong organizational and multi-tasking abilities.</li><li>Independent and Collaborative: Capable of working both independently and collaboratively in a fast-paced environment.</li></ul>PREFERRED KNOWLEDGE, SKILLS, AND ABILITIES:Knowledge:<ul><li>Non-Traditional Students: Experience with non-traditional student populations.</li><li>Credentialing Information: Knowledge about credential program information and school credentialing requirements.</li><li>Industry Knowledge: Familiarity with the education sector.</li><li>Sales Knowledge: Familiarity with sales and account management.</li></ul>Skills:<ul><li>Professional Interaction: Skilled in networking and group presentations.</li><li>Inquiry Management: Effective in generating and following up on inquiries.</li><li>Public Speaking: Excellent presentation skills.</li></ul>Abilities:<ul><li>Self-Motivated: Goal-oriented and proactive in recruiting students.</li><li>Event Coordination: Proficient in planning logistics and coordinating events.</li><li>Consistent Performance: Proven track record of consistent results.</li><li>Admissions Guidance: Experienced in enrollment and academic advising.</li><li>Positive Attitude: Promotes a healthy work environment.</li><li>Travel and Flexibility: Willing to travel and work flexible hours, including evenings and weekends.</li></ul>POSITION QUALIFICATIONS:Required:<ul><li>Education: Bachelor’s degree or 3-4 years of work experience in admissions, recruitment or enrollment.</li></ul>Preferred:<ul><li>Experience: 1 year of college admissions, non-traditional higher education recruitment, or sales experience preferred.</li></ul>TYPICAL WORKING CONDITIONS<ul><li>Office environment; typically, 70 degrees</li><li>Noise level is usually quiet to moderately noisy while in the office</li></ul>EQUIPMENT USED:<ul><li>Computer/Laptop</li><li>Telephone</li><li>Copier, scanner and fax machines</li></ul>ESSENTIAL PHYSICAL &amp; MENTAL TASKS:Physical Demands: ☒ Standing&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Lifting:&nbsp; 10 Lbs.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;☒ Pushing/Pulling&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Driving☐ Walking&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Carrying&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;☒ Hearing&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Speaking☐ Reaching&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Writing &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Squatting/Kneeling&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Seeing☐ Climbing&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Pushing&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Other:&nbsp; TypingPhysical Environment - Exposed to:&nbsp; ☒ Noise&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Heat/Cold&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Fumes/Gases&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;☐ Human Tissue/Fluids☐ Chemicals&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Carcinogens&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Dirt&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;☐ Animal Tissue/Fluids☐ Toxic Chemicals&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Radiation&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐Other:&nbsp;☐ Biohazardous MaterialMental Demands:&nbsp; ☒ Reading&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;☒ Frequent Interruptions&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;☒ Periods of Concentrated Attention&nbsp;&nbsp;&nbsp;☒ Detailed Work&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Irregular Work Schedule&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;☒ Frequent Contact with People☒ Frequent Deadlines&nbsp;&nbsp;&nbsp;&nbsp;☐Other:&nbsp;☒ Multiple Concurrent TasksTRAVEL: Up to 5% of total timeENVIRONMENTAL CONDITIONS:The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job:&nbsp;The noise level in the work environment is usually quite to moderately noisy while in the office.&nbsp; The office temperature is about 70 degrees.DECISION MAKING:The position is governed by the policies of Pacific Oaks, along with established procedures for the department.CONTACT RESPONSIBILITIES:Routine exchange or presentation of information.Responsible for demonstrating professionalism and leadership in resolving conflicts with students and employees.&nbsp; Recommends alternative approaches to solve problems and conflicts.&nbsp;FINANCIAL RESPONSIBILITY:This position does not require the management of budgets, but it is required to follow Pacific Oaks policies for purchasing and budget approvals.Compensation &amp; BenefitsThis opportunity is budgeted at $20.00-21.50 base compensation. Additional compensation factors may impact total compensation. To learn more about our competitive benefits and additional rewards, including generous paid time-off, medical and dental insurance coverage, life and disability insurance, retirement plan with employer contribution, multiple flexible spending accounts, tuition reimbursement, click the link below.<a href="https://www.pacificoaks.edu/about/careers-pacific-oaks/" target="_blank">https://www.pacificoaks.edu/about/careers-pacific-oaks/</a>Pacific Oaks is an Equal Opportunity Employer.Pacific Oaks participates in E-Verify and verifies identity and employment eligibility of all persons hired. The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. Pacific Oaks offers equal employment opportunities to all persons without regard to race, color, ethnicity, religion, sex, sexual orientation, national origin, age, marital status, physical or mental disability, parental status, housing status, source of income or military status, in accordance with applicable federal, state and local EEO laws.

Pacific Oaks Children’s School

Enrollment Counselor

Dialysis Registered Nurse - Part Time| MWF

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;Monday - Friday, 8 a.m. to 5 p.m. PST, with rotating holidays.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> Nearest Major Market: Los Angeles Job Segment: Nursing, Registered Nurse, Medicare, Medicaid, Pharmacy, Healthcare

Customer Solution Center Appeals and Grievances Nurse Specialist RN II

<h4>Job Description</h4>Job DescriptionIMCS Group is a Healthcare and Professional Staffing Company. From nursing staffing, temp to hire, and permanent to healthcare contracts, IMCS Group provides hospitals and medical facilities with high-quality clinical professionals with the highest standards and compliance to provide the best medical care.Job Duties / Responsibilities• Conducting intake assessments with patients and families. • Ensuring that families feel sufficiently equipped and supported. • Developing individualized treatment plans that account for physical, financial, and other constraints. • Adjusting treatment protocols, as needed. • Suggesting and coordinating appropriate follow-up services to promote wellness. • Ensuring that patients have transport to and from their homes and all pertinent healthcare facilities. • Meeting with members of healthcare teams to discuss patients’ progress, and to deliberate on appropriate care. • Checking to see whether patients have sufficient insurance coverage or finances to pay for their treatment. • Devising innovative solutions or suggesting appropriate referrals for patients who cannot afford to access treatment.Job Requirements: Experience / License / Certification / Education etc.• At least 1-2 year’s Current RN (Case Manager) Experience – Required • RN Active License – Required • BLS through AHA – Required • COVID 19 Vaccinated – Required

11 Social Services Jobs in Los Angeles, CA, USA