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<p>Salary Range:&nbsp;&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)</p><p>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 in five health plans, we make sure our members get the right care at the right place at the right time.<br><br>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.<br></p><h4>Job Summary</h4><p>The Utilization Management Clinical Quality Nurse Reviewer RN II, under the purview the Utilization Management (UM) Department Leadership Team, is responsible for conducting and tracking targeted and random internal department documentation audits. This role is ensures that UM practices and supporting documentation are compliant with all regulatory requirements. &nbsp;The Incumbent also serves as a Subject Matter Expert during external audits as well as leads pre- and post-audit preparation/follow-up.&nbsp; This position actively participates in development and review of policies and procedures to certify compliance with regulatory guidelines and mandates. This position will focus on UM cases for all lines of business to identify areas of opportunity for increasing positive audit outcomes and improved service to L.A. Care’s membership. This position is responsible for identifying and monitoring staff (non-clinical, nurse, and physician) performance against key performance indicator trends that warrant recognition or remediation. This position performs data mining and analysis and create reports on audit findings, as well as make recommendations, to submit to the department's Quality Assurance Team and UM Management.</p><h4>Duties</h4><p>Facilitates the development, review, and revision of organizational and departmental process flows to ensure compliance with relevant regulatory, organizational, and departmental guidelines.</p><p>Keenly focuses on practices and documentation of clinical staff, serving as a resource on state and federal industry mandates applicable to UM functions.</p><p>Generates results of findings, enhances, and analyzes various reports related, but not limited to, quality and accuracy of case documentation.&nbsp;</p><p>Works with department leadership to assess for all opportunities related to quality improvements.&nbsp;</p><p>Compiles and presents quality report cards that measure adherence to quality and regulatory compliance.&nbsp;</p><p>Keeps UM Leadership apprised of departmental and industry trends, deficiencies, and any potential risks, and collaborates with the team to develop and execute mitigation efforts.</p><p>Serves as a consultant to the organization's Compliance team on an ad hoc basis.</p><p>Performs other duties as assigned.&nbsp;</p><h4>Duties Continued</h4><h4>Education Required</h4>Associate's Degree in Nursing<h4>Education Preferred</h4>Bachelor's DegreeMaster's Degree in Nursing<h4>Experience</h4><p>Required:&nbsp;<br>At least 5 years of experience in Clinical Nursing. Minimum of 2 years of auditing clinical documentation. &nbsp;Active participation in at least two state regulatory audits and one federal regulatory audits. Previous experience with Medi-Cal and Medicare in a managed care environment and experience with mitigation planning and implementation.</p><p>Preferred: &nbsp;<br>Experience performing clinical documentation for a health plan. Active participation in at least three state regulatory audits, at least one National Committee for Quality Assurance (NCQA) audit and/or Centers for Medicare and Medicaid Services (CMS) audit. &nbsp;Background in teaching and/or clinical education.</p><h4>Skills</h4><p>Required:&nbsp;<br>Superior verbal and written communication skills.&nbsp;</p><p>Advanced computer proficiency in both Microsoft Word and Excel.&nbsp;</p><p>Strong analytical and team building skills.&nbsp;</p><p>Ability to work independently and be self-directed.&nbsp;</p><p>Ability to work effectively with diverse team members.&nbsp;</p><p>Strong problem-solving skills.&nbsp;</p><p>Ability to multitask and streamline day-to-day operations.&nbsp;</p><p>Ability to translate regulatory requirements into auditable tools.&nbsp;</p><p>Preferred:</p><p>Proven ability to lead successful performance improvement projects.</p><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><p>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.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><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

Utilization Management Clinical Quality Nurse Reviewer RN II

<h4><em>How you will change lives</em></h4><p>As a Patient Care Technician (PCT) at US Renal Care, you will be an integral part of a cross-functional team providing care and delegated activities of treatment to patients. The PCT will work under the supervision of a Registered Nurse (RN) or Charge Nurse (CN) for patients with renal failure.</p><h4><em>What you'll be doing</em></h4><p><strong>Patient care.</strong> You will work directly with patients to provide safe, comfortable, and high-quality dialysis treatment. Responsibilities include gathering patient stats before and after treatment, initiating treatment, monitoring patients during treatment, terminating treatment, and collecting patient blood samples per physician orders.</p><p><strong>Technician Duties. </strong> You will ensure quality comes first by preparing machines for hemodialysis treatments, cleaning and disinfecting machines after treatment, and conducting machine safety checks and logging results for quality control, ensuring all protocols and regulations are followed.</p><p><strong>Safety and Quality. </strong> You will use appropriate safety measures, including personal protective equipment. Working under the supervision of a Charge Nurse, you will adhere to all company policies, procedures, and state/federal laws and regulations. You will participate in all required staff meetings and continuing education offerings.</p><p><strong>PATIENT CARE TECHNICIAN<br>STATE SPECIFIC BOARD OF NURSING REQUIREMENTS </strong></p><strong>California</strong><ul><li>Must possess current Certified Hemodialysis Technician (CHT) certificate from California Department of Public Health (CDPH) at time of hire OR</li><li>Hired at USRC location recognized by state of California as an approved dialysis technician training program and obtain California state certification (CHT) within six (6) weeks of successful completion of training program. </li></ul><strong>Maryland</strong><ul><li>Must possess current Certified Nursing Assistants -- Dialysis Technicians (CNA-DT) certificate from Maryland Board of Nursing OR</li><li>Hired at USRC location recognized by state of Maryland as an approved dialysis technician training program and obtain Maryland CNA-DT certificate within three (3) months from date of hire OR</li><li>Out-of-state applicant must have active BONENT certification and provide proof of initial application for CNA-DT certification.</li></ul><strong>New Mexico</strong><ul><li>Must have New Mexico dialysis technician certificate at time of hire <strong>OR</strong></li><li>Hired at USRC location recognized by state of New Mexico as an approved dialysis technician training program and obtain New Mexico state certification within six (6) months of successful completion of training program <strong>OR</strong></li><li>New Mexico certification of hemodialysis technician is required for out of state applicant with active state or national hemodialysis certification; must obtain New Mexico state certification prior to working as a Certified Hemodialysis Technician. </li><li>After January 1st, 2024, all initial applications for the certified hemodialysis technician will require a national hemodialysis technician certificate.</li><li>The applicant must submit proof of a valid national hemodialysis technician certificate from a recognized organization.</li><li>Hemodialysis technician students must have a current basic life support credential prior to and while the student has contact with patients</li></ul><strong>OHIO</strong><ul><li>Must have Ohio dialysis technician intern certificate at time of hire OR</li><li>Hired at USRC location recognized by state of Ohio as an approved dialysis technician training program and submit application for Ohio dialysis technician intern certificate to board no later than four (4) weeks prior to completion of the approved training program.</li><li>Must obtain Ohio Board of Nursing Certificate (OCDT) not less than twelve (12) months and not later than eighteen (18) months of enrolling in the USRC OCDT program.</li></ul><strong>OREGON</strong><ul><li>Must possess current Certified Hemodialysis Technician (CHDT) certificate from Oregon Public Health Division at time of hire OR</li><li>Must obtain Oregon dialysis technician provisional certificate within three (3) weeks of successful completion of training program and obtain Certified Hemodialysis Technician (CHDT) certificate from Oregon Public Health Division within eighteen (18) months. An Oregon Provisional Certification is valid for six months and can be renewed for one additional six month period.</li></ul>&nbsp;<br>

U.S. Renal Care

Dialysis Patient Care Technician MWF

<h4><em><strong>How you will change lives</strong></em></h4><p>As a Patient Care Technician (PCT) at US Renal Care, you will be an integral part of a cross-functional team providing care and delegated activities of treatment to patients. The PCT will work under the supervision of a Registered Nurse (RN) or Charge Nurse (CN) for patients with renal failure.</p><h4><em><strong>What you'll be doing</strong></em></h4><p><strong>Patient care.</strong> You will work directly with patients to provide safe, comfortable, and high-quality dialysis treatment. Responsibilities include gathering patient stats before and after treatment, initiating treatment, monitoring patients during treatment, terminating treatment, and collecting patient blood samples per physician orders.</p><p><strong>Technician Duties. </strong>You will ensure quality comes first by preparing machines for hemodialysis treatments, cleaning and disinfecting machines after treatment, and conducting machine safety checks and logging results for quality control, ensuring all protocols and regulations are followed.</p><p><strong>Safety and Quality. </strong>You will use appropriate safety measures, including personal protective equipment. Working under the supervision of a Charge Nurse, you will adhere to all company policies, procedures, and state/federal laws and regulations. You will participate in all required staff meetings and continuing education offerings.</p><p><strong>PATIENT CARE TECHNICIAN<br>STATE SPECIFIC BOARD OF NURSING REQUIREMENTS </strong></p><strong>California</strong><ul><li>Must possess current Certified Hemodialysis Technician (CHT) certificate from California Department of Public Health (CDPH) at time of hire OR</li><li>Hired at USRC location recognized by state of California as an approved dialysis technician training program and obtain California state certification (CHT) within six (6) weeks of successful completion of training program. </li></ul><strong>Maryland</strong><ul><li>Must possess current Certified Nursing Assistants -- Dialysis Technicians (CNA-DT) certificate from Maryland Board of Nursing OR</li><li>Hired at USRC location recognized by state of Maryland as an approved dialysis technician training program and obtain Maryland CNA-DT certificate within three (3) months from date of hire OR</li><li>Out-of-state applicant must have active BONENT certification and provide proof of initial application for CNA-DT certification.</li></ul><strong>New Mexico</strong><ul><li>Must have New Mexico dialysis technician certificate at time of hire <strong>OR</strong></li><li>Hired at USRC location recognized by state of New Mexico as an approved dialysis technician training program and obtain New Mexico state certification within six (6) months of successful completion of training program <strong>OR</strong></li><li>New Mexico certification of hemodialysis technician is required for out of state applicant with active state or national hemodialysis certification; must obtain New Mexico state certification prior to working as a Certified Hemodialysis Technician. </li><li>After January 1st, 2024, all initial applications for the certified hemodialysis technician will require a national hemodialysis technician certificate.</li><li>The applicant must submit proof of a valid national hemodialysis technician certificate from a recognized organization.</li><li>Hemodialysis technician students must have a current basic life support credential prior to and while the student has contact with patients</li></ul><strong>OHIO</strong><ul><li>Must have Ohio dialysis technician intern certificate at time of hire OR</li><li>Hired at USRC location recognized by state of Ohio as an approved dialysis technician training program and submit application for Ohio dialysis technician intern certificate to board no later than four (4) weeks prior to completion of the approved training program.</li><li>Must obtain Ohio Board of Nursing Certificate (OCDT) not less than twelve (12) months and not later than eighteen (18) months of enrolling in the USRC OCDT program.</li></ul><strong>OREGON</strong><ul><li>Must possess current Certified Hemodialysis Technician (CHDT) certificate from Oregon Public Health Division at time of hire OR</li><li>Must obtain Oregon dialysis technician provisional certificate within three (3) weeks of successful completion of training program and obtain Certified Hemodialysis Technician (CHDT) certificate from Oregon Public Health Division within eighteen (18) months. An Oregon Provisional Certification is valid for six months and can be renewed for one additional six month period.</li></ul>&nbsp;<br>

Dialysis Patient Care Technician Floater TTS

<p>At West Coast University, we share a&nbsp;passion for students and transforming healthcare education!&nbsp;As a faculty member for a certified Great Place to Work, you willjoin a collaborative, student-centric culture valuing academic integrity, mutual respect, student learning, service, responsiveness, innovation, diversity, and stewardship.&nbsp;As a part of this team, you will guide students to do more than change their own lives&nbsp;–&nbsp;you will help change the lives of every patient they care for throughout their career.&nbsp;</p><p><strong>You will make an impact by:</strong></p><ul><li>Providing program-specific expertise and is actively engaged in relevant department initiatives. Supporting University, Campus, and/or departmental goals to assure compliance with programmatic accreditation and/or licensure, internal consistency, and graduate outcomes that meet student learning, workplace, and placement expectations. </li><li>Providing professional leadership and support, and serving as an educator, role model, mentor and facilitator.</li><li>Creating an educational environment which fosters innovation, responsiveness, and accountability. Focuses extensively on facilitating student learning associated with prescribed course and program learning outcomes.</li><li>Actively and substantively participating in assessment of student learning activities to maximize the potential for students to learn what is necessary to meet prescribed outcomes.</li><li>Vigorously upholding a culture of academic integrity.</li></ul><p><strong>Your Experience Includes:</strong></p><ul><li>Greater than 3 years of clinical experience</li><li>Experience teaching in a PA program or Medical School preferred.</li><li>Experience with ARC-PA accreditation in provisional and/or maintenance phase preferred.</li><li>Non-doctoral faculty: doctoral degree or willingness to enter and complete a doctoral program</li></ul><p><strong>Education:</strong></p><ul><li>Master’s degree, Physician Assistant; or</li><li>Master’s degree, or higher, in health-related field</li></ul><p>If a non-clinician scientist (Scientist Position):</p><ul><li>Doctorate degree in health- or social-science related field.</li><li>Minimum of three years teaching/research/clinical experience.</li></ul><p>Preferred:</p><ul><li>NCCPA certified Physician Assistant or Board certified allopathic or osteopathic physician</li><li>PA license (or eligible) or MD / DO license or eligible for licensure in Texas</li></ul><p>#LI-AM1</p><p>#HEJ</p>

West Coast University

Adjunct Faculty, Physician Assistant (Hybrid)

<p><strong>At West Coast University, we share a passion for students and transforming healthcare education! As a faculty member for a certified Great Place to Work, you will join a collaborative, student-centric culture valuing academic integrity, mutual respect, student learning, service, responsiveness, innovation, diversity, and stewardship.&nbsp; As a part of this team, you will guide students to do more than change their own lives – you will help change the lives of every patient they care for throughout their career.&nbsp; </strong></p><p>The Director of Academic Education for the Physician Assistant Program assists with the development of the program including the development of the program curriculum which includes content, syllabi, delivery and assessment of the didactic portion of the Physician Assistant Program. The Director of Academic Education will oversee and develop policies and procedures relevant to the academic environment. Assists with program compliance according to state specific as well as Accreditation Review Commission on Education for Physician Assistant (ARC-PA) Standards.</p><p>Essential Functions and Responsibilities</p><ul><li>The Director of Academic Education will perform essential duties of a principal faculty member, additionally providing leadership, exceptional academic instruction, assistance with curriculum oversight and academic policies alongside the Program Director to the faculty and students.</li><li>Assists designing, implementing, coordinating, and evaluating the didactic component of an approved curriculum to meet degree requirements. Assists with the review modification and evaluation of syllabi, textbooks, and learning outcomes across the program. Ensures consistency of practice, protocols, and processes with respect to University academic practices.</li><li>Assists with the organization, monitoring, assessment, and implementation of a professional Physician Assistant (PA) Program (Master of Physician Assistant [MPA] degree) in accordance with the accreditation standards and requirements of the ARC-PA.</li><li>May serve as the co-chair of the West Coast University MPA Program Curriculum and Assessment Committee.</li><li>Performs ongoing curriculum review and analysis through curriculum mapping and programmatic assessment of the didactic phase of the program.</li><li>Designs and implements action plans to address any areas in the curriculum that needs improvement or updating in response to changes in the entry level clinical knowledge requirements, changes in state licensure requirements or ARC-PA requirements.</li><li>Coordination of instructional content to students in coordination with MPA Program staff, faculty, and adjunct faculty.</li><li>Serves as a liaison to adjunct faculty members teaching and performing duties in the MPA Program.</li><li>Oversees maintenance of course files consistent with ARC-PA Standards.</li><li>Must be knowledgeable of:</li><ul><li>Database performance reports and manages, analyzes, interprets and reports performance databases and the processes of data collection and analysis for the didactic portion of the West Coast University MPA Program,</li><li>Reviews and interprets exam statistics throughout the didactic year courses.</li><li>Oversees didactic remediation processes for students.</li><li>Collects and reviews semester exam schedules.</li></ul></ul><p>Preferred Education, Certifications and Licensures</p><ul><li>Doctoral degree that is awarded by an institution that is accredited by a regional accrediting body is preferred.</li></ul><p>Required Education, Certifications, and Licensures</p><ul><li>Physician Assistant graduate from an ARC-PA accredited Physician Assistant program.</li><li>Master's degree in PA studies or other discipline.</li><li>Candidate should hold current NCCPA Certification and be licensed to practice in the applicable state.</li></ul><p>Required Experience and Skills</p><ul><li>Minimum of three years (five years preferred) in the field of physician assistant, including documented clinical practice as a physician assistant.</li><li>At least three (3) years of experience in a full-time academic appointment with teaching responsibilities at the post-secondary level.</li><li>Knowledge of state, federal and local laws/regulations relating to programs, governmental compliance and other regulatory standards such as Title IV, WASC, ARC-PA, APTA, CAPTE and other accreditation standards.</li></ul>

Campus Director, Academic Education - Physician Assistant

Dialysis Patient Care Technician - PRN

<br><h4><em><strong>How you'll change lives</strong></em></h4><p>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.</p><h4><em><strong>What you'll be doing</strong></em></h4><p><strong>Patient care.</strong> 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. </p><p><strong>Teamwork.</strong> 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.</p><p><strong>Safety &amp; Quality.</strong> 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.</p>

Dialysis Registered Nurse PRN

<p>Salary Range:&nbsp;&nbsp;$67,186.00&nbsp;(Min.) -&nbsp;$87,342.00&nbsp;(Mid.) -&nbsp;$107,498.00&nbsp;(Max.)</p><p>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 in five health plans, we make sure our members get the right care at the right place at the right time.<br><br>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.<br></p><h4>Job Summary</h4><p><br>The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II is primarily responsible for the overall coordination of the Appeals &amp; Grievance program for L.A. Care Health Plan members under the direct supervision and management of the A&amp;G Nurse Specialist, RN and/or Medical Director. This position provides assistance to members with health care access and benefit coordination issues, ensuring that clinical grievances and complex issues are investigated and resolved to the member’s satisfaction consistent with L.A. Care Health Plan and regulatory guidelines. Benefit coordination may involve coordinating multiple L.A. Care Health Plan Lines of Business.&nbsp;</p><h4>Duties</h4><p>Works with Registered Nurses and Medical Directors to appropriately investigate, review and resolve clinical appeals and grievances. Prepares Nurse Summary for MD review and determination. Performs clinical review of medical records related to grievances and appeals. Responsible for handling member and provider appeals providing clinical reviews and write-ups and recommendations, mailing and faxing of resolution letters.</p><p><br>Reviews grievance cases that require immediate clinical quality of care, initial coding of member grievance and evaluation and/or require immediate pre-service authorization evaluation.</p><p>Investigates Provider Disputes/PDR and prepares clinical summary for Medical Director determination.&nbsp;</p><p>Work with the external providers and PPGs representatives to obtain relevant medical records and communication documentation.</p><p>Investigation and preparation of State Fair Hearing cases as assigned.</p><p>Prepare resolved complaint files for Centers for Medicare and Medicaid Services(CMS), external review organization (QIO or IRE).</p><p>Work with Utilization Management and PNO to facilitate completion of resolution determination.</p><p>Investigate, prepare summary and work with Medical Directors to resolve expedited cases within regulatory timelines. Maintain knowledge of regulatory changes related to all grievances and appeals and meets regulatory requirements. Refers cases for further follow-up or notification as appropriate, e.g. fraud and abuse cases shall be forwarded to Compliance Department.</p><p>Perform other duties as assigned.</p><h4>Duties Continued</h4><h4>Education Required</h4>Associate's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p><strong>Required:</strong><br>At least 4 years of clinical nurse and managed care experience.</p><h4>Skills</h4><p><br><strong>Required:</strong><br>Excellent interpersonal and communication skills.&nbsp;</p><p>Good working knowledge of regulatory requirements/standards.&nbsp;</p><p>Computer literacy and adaptability to computer learning.&nbsp;</p><p>Time management and priority setting skills.</p><p>Must be organized and a team player, able to work effectively with various internal business units, Plan Partners, participating provider groups, and external agencies.</p><h4>Licenses/Certifications Required</h4>Licensed Vocational Nurse (LVN) - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><p><strong>Required:</strong><br>License Vocational Nursing (LVN)</p><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>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.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><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>

33 Healthcare / Pharmacy Jobs in Beverly Hills, CA, USA