Current jobs related to Clinical Assurance Compliance Nurse Specialist RN II - Los Angeles - L.A. Care Health Plan
-
Quality Assurance Nurse and Compliance Specialist
2 months ago
Los Angeles, California, United States Preferred IPA of California Full timeJob OverviewPositions available for a Quality Assurance Nurse and a Compliance Specialist. QUALITY ASSURANCE NURSEOBJECTIVE:The Quality Assurance Nurse plays a crucial role in collaboration with the Medical Director, the VP of Clinical Policy, and the Quality Management Committee to develop, implement, and enhance the Quality Management Program. This...
-
Regulatory Compliance Specialist II
2 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeJob SummaryThe Regulatory Compliance Specialist II is responsible for ensuring the Customer Solution Center (CSC) is ready for regulatory audits. This position will develop a successful auditing strategy for end-to-end processes within CSC, including enrollment processing, timeliness and accuracy of loading members, and outbound health risk assessment calls....
-
Regulatory Compliance Specialist II
2 months ago
Los Angeles, California, United States L.A. Care Health Plan Full timeJob SummaryThe Regulatory Compliance Specialist II is responsible for ensuring the Customer Solution Center's readiness for regulatory audits. This position will develop a comprehensive auditing strategy for end-to-end processes, including enrollment processing, member interactions, and service authorization requests. The Specialist will also be responsible...
-
Utilization Management Nurse Specialist RN II
4 weeks ago
Los Angeles, United States oilandgas.org.uk Full timeSalary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (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...
-
Clinical Research Associate II
4 weeks ago
Los Angeles, California, United States CEDARS-SINAI Full timeJob SummaryCedars-Sinai is seeking a highly skilled Research Associate II to join our team in the Angeles Research Institute. This is a dynamic role that requires a strong background in clinical research and regulatory compliance.The successful candidate will be responsible for ensuring the timely submission of complete, accurate, and current documents to...
-
Quality Assurance Specialist
6 days ago
Los Angeles, California, United States Vista Del Mar Child & Family Services Full timeJob Title: Quality Assurance SpecialistVista Del Mar Child & Family Services is seeking a highly skilled Quality Assurance Specialist to join our team. As a Quality Assurance Specialist, you will play a critical role in ensuring the quality and compliance of our programs, particularly in Home Study and Post Release Services.Key Responsibilities:Conduct...
-
Clinical Operations Coordinator II RN
2 weeks ago
Los Angeles, California, United States Cedars-Sinai Full timeClinical Operations Coordinator II RN Job DescriptionCedars-Sinai is seeking a highly skilled Clinical Operations Coordinator II RN to join our team. As a key member of our clinical operations team, you will play a critical role in promoting quality care and ensuring consistency in clinical practices.Key Responsibilities:Provide direct patient care as needed...
-
Nurse Specialist II
4 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeJob SummaryThe Facility Site Review (FSR) Nurse Specialist RN II plays a critical role in ensuring quality FSR and physician compliance with Local, State, and Federal requirements. This position conducts Full Scope Reviews, Site Review Surveys, Medical Record Review Surveys, Specialty Site Review Surveys, physical accessibility review survey (PARS)...
-
Clinical Research Data Specialist II
2 weeks ago
Los Angeles, California, United States University of Southern California Full timeJob SummaryThe University of Southern California (USC) is seeking a highly motivated and qualified Clinical Research Data Specialist II to join our team. As a key member of our research team, you will be responsible for coordinating and managing clinical data for various phases of clinical studies.Key ResponsibilitiesCoordinate and manage clinical data for...
-
Clinical Policy Initiatives Nurse II
2 weeks ago
Los Angeles, California, United States Scout Exchange Full timeJob Summary:The Utilization Management Policy Initiatives Nurse II is responsible for managing, reviewing, updating, and creating Healthcare Services clinical policies, guidelines, protocols, and related documentation. This role ensures that the day-to-day functions of Utilization Management initiatives comply with regulatory and accreditation...
-
Clinical Nurse II
4 weeks ago
Los Angeles, California, United States Cedars-Sinai Full timeCedars-Sinai Clinical Nurse II Job DescriptionCedars-Sinai is seeking a skilled Clinical Nurse II to join our team. As a Clinical Nurse II, you will provide high-quality patient care in a dynamic and fast-paced environment.Key Responsibilities:Provide nursing care to patients in a skilled and effective manner.Establish a plan of care, set goals, determine...
-
Supervising Clinical Laboratory Scientist II
3 weeks ago
Los Angeles, California, United States The County of Los Angeles Full timeJob Title: Supervising Clinical Laboratory Scientist IIJoin the County of Los Angeles Department of Health Services as a Supervising Clinical Laboratory Scientist II and play a critical role in ensuring the highest quality laboratory services for our patients and communities.Job Summary:We are seeking a highly skilled and experienced Supervising Clinical...
-
Los Angeles, California, United States L.A. Care Health Plan Full timeClinical Utilization Management Liaison RN II**Job Summary**The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for receiving and reviewing admission requests and higher levels of care (HLOC) transfer requests from inpatient facilities within regular timelines. Reviews clinical data in real-time and post-admission to issue a...
-
Clinical Research Data Specialist II
2 weeks ago
Los Angeles, California, United States Cedars-Sinai Full timeThe Smidt Heart Institute at Cedars-Sinai is a leading center for heart disease research and innovation, providing patients with access to the highest level of care.Our MissionWe are committed to advancing the field of heart disease research and improving patient outcomes through cutting-edge technology, innovative treatments, and groundbreaking...
-
Los Angeles, California, United States Kaiser Permanente Full timeResearch Associate II, Clinical Trials Specialist**Job Summary:**We are seeking a highly skilled Research Associate II, Clinical Trials Specialist to join our team at Kaiser Permanente. This role will be responsible for coordinating day-to-day activities of several small-scale projects or phases of one or more larger projects. The ideal candidate will have a...
-
Pediatric Cardiac ICU Clinical Nurse Specialist
4 weeks ago
Los Angeles, California, United States Clinical Management Consultants Full timeCardiac ICU Clinical Nurse Specialist OpportunityWe are seeking an exceptional Cardiac ICU Clinical Nurse Specialist to join our world-class pediatric care team at a leading Children's Hospital in Southern California.The successful candidate will play a pivotal role in providing advanced nursing care to critically ill children with complex cardiac...
-
Clinical Research Data Specialist II
4 weeks ago
Los Angeles, California, United States CEDARS-SINAI Full timeJob SummaryCedars-Sinai Medical Center is seeking a highly skilled Clinical Research Data Specialist II to join our team in the Heart Institute. This role will be responsible for managing data for assigned research studies, including designing forms for data collection, clinical data abstraction, processing data, and producing project reports.The ideal...
-
Utilization Management Nurse Specialist RN II
4 weeks ago
Los Angeles, United States L.A. Care Health Plan Full timePress Tab to Move to Skip to Content Link Select how often (in days) to receive an alert: Job Category: Clinical Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 11587 Salary Range: $88,854.00(Min.) -$115,509.00(Mid.) -$142,166.00(Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the...
-
Clinical Research Data Specialist II
2 weeks ago
Los Angeles, California, United States Cedars-Sinai Full timeJob SummaryCedars-Sinai Medical Center is seeking a highly skilled Clinical Research Data Specialist II to join our team in the Heart Institute. This role will be responsible for managing data for assigned research studies, including designing forms for data collection, clinical data abstraction, processing data, and producing project reports.The ideal...
-
Pediatric Cardiac ICU Clinical Nurse Specialist
4 weeks ago
Los Angeles, California, United States Clinical Management Consultants Full timeSeeking an Exceptional Pediatric Cardiac ICU Clinical Nurse SpecialistClinical Management Consultants is seeking a highly skilled Pediatric Cardiac ICU Clinical Nurse Specialist to join our team at a world-class children's hospital in Southern California. The ideal candidate will possess advanced knowledge in pediatric cardiac critical care and demonstrate...
Clinical Assurance Compliance Nurse Specialist RN II
3 months ago
Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (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.
The Clinical Assurance Compliance Nurse Specialist RN II is responsible for the review of regulatory, contractual and accreditation standards to ensure Health Care Services Department policies are in compliance and in operation. The position works closely with Regulatory Affairs and Compliance to ensure timely exchange of documentation to evidence compliance. The position is responsible for the internal auditing process for referral management and complex case management using approved auditing/monitoring tools. This position participates in the review and presentation when necessary of training materials for external delegates and internal staff training.
Duties Assist in the continual maintenance of Health Services Policies/Procedures, letter templates, Workflows, Process, Audit Tools and Training Materials in compliance with regulatory requirements, new legislation and accreditation standards. Work collaboratively with Regulatory Affairs & Compliance to ensure Health Services Departments are made aware and department documents updated accordingly. Develop and maintain Medical Management training materials in compliance with all regulatory requirements, new legislation, and accreditation standards. Assist in the preparation of the Health Services Departments for review by external regulatory and accrediting bodies (Department of Health Care Services (DHCS), A&I, DHCS Member Rights, Department of Managed Health Care (DMHC), National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services(CMS)) and internally for audits by Real Application Clusters (RAC) through team processes. Assist in the development and revisions of audit tools, Policies, provider trainings to improve compliance with regulatory and accreditation standards. Develop and implement procedures to assurance compliance with care coordination and documentation of Utilization Management (UM) and CM element. Provide training, education and consultation as necessary to delegates. Collaborate with other UM staff on identifying topics and developing agendas for the JOMs/performance visits/communications. Maintain confidentiality in compliance with all Health Insurance Portability and Accountability Act (HIPAA) requirements. Assist co-workers with special projects or work volume as required. Actively identify and implement efforts to improve the quality, effectiveness and efficiency of job functions. Communicate to supervisors any barriers to completing assignments or daily work with delegates in an efficient and effective manner. Demonstrate reliability and good attendance and punctuality standards.Perform other duties as assigned.
Duties Continued Education Required Associate's Degree in NursingEducation Preferred Bachelor's Degree in NursingExperienceRequired:
At least 5 years of experience in a clinical setting and managed care plan performing UM oversight, including auditing.
Managed Health Care experience.
SkillsRequired:
Good working knowledge of licensure and regulatory requirements, and accreditation standards.
Ability to manage and organize large volumes of data.
Knowledge of regulatory and accreditation entities and their requirements.
Excellent verbal and written communication skills; excellent interpersonal skills.
Proficient in MS Office applications.
Ability to work independently. Ability to solve complex problems/issues and identify creative solutions.
Knowledge of issues pertaining to Medi-Cal, Medicare, and other Health Maintenance Organization (HMO) & Independent Practice Association (IPA) contracts and payers.
Licenses/Certifications Required Registered Nurse (RN) - Active, current and unrestricted California LicenseLicenses/Certifications Preferred Certified Professional in Utilization Review (CPUR)Certified Case Manager (CCM)Certified Professional in Healthcare Quality (CPHQ)Required Training Physical Requirements LightAdditional InformationSalary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
