Clinical Consultant

4 weeks ago


Pasadena, California, United States Kaiser Permanente Full time
Job Summary:

As a Regional Home Care RN Consultant at Kaiser Permanente, you will provide clinical expertise to areas of compliance involving medical necessity and quality concerns. You will utilize your clinical expertise to conduct investigations and seek input from other clinical professionals as required. Your role will involve acting as a liaison, problem-solver, and negotiator to achieve resolution on member requests and appeals.

Key Responsibilities:
  • Work directly with Member Services organization and other clinical and administrative leadership to investigate and facilitate resolution of complex and high-profile member requests and appeals.
  • Identify gaps in clinical expertise for areas of compliance involving medical necessity and/or quality concerns.
  • Utilize clinical expertise to conduct investigations and seek input from other clinical professionals as required.
  • Act as a liaison, problem-solver, and project manager to close clinical, quality, educational, and compliance gaps.
  • Review member complaints to identify potential quality issues that should be referred to the local Quality teams.
  • Develop resources and implement solutions for all levels of Home Care staff.
  • Ensure action plans are carried out, tracked, and completed.
  • Provide direct support and consultation on corrective actions developed by departments for areas of non-compliance to ensure the compliance issue(s) is adequately addressed.
  • Assist in the development of appropriate policies relating to compliance, clinical, and quality.
  • Participate in the development and implementation of necessary educational programs to ensure all appropriate parties are knowledgeable about their compliance responsibilities on an ongoing basis.
Requirements:
  • Minimum five (5) years of nursing staff, consultant, or management experience in ambulatory, inpatient, or care at home settings.
  • Graduate of an accredited school of nursing required.
  • Registered Nurse degree required.
  • Registered Nurse License (California) required.
  • Personal transportation required for local Service Area travel.
  • May require some travel to the Service Areas and/or Regional offices across the Division.


  • Pasadena, California, United States Kaiser Permanente Full time

    Job Summary:As a Nursing Education Consultant at Kaiser Permanente, you will provide strategic planning and consultative services to senior executives and nursing leaders in the areas of nursing professional education, development, and continuous learning. Your goal will be to assess, evaluate, maintain, improve, and develop professional nursing practices,...


  • Pasadena, California, United States Kaiser Permanente Full time

    Job Summary:As a Nursing Professional Development Consultant at Kaiser Permanente, you will play a critical role in assessing and evaluating professional nursing practices to maintain, improve, and develop them. You will be responsible for managing the design, implementation, and evaluation of professional nursing education and development programs in the...

  • Clinical Psychologist

    1 month ago


    Pasadena, California, United States Dr Kate Truitt & Associates A Psychological Corporation Full time

    Job OpportunityWe are seeking a highly skilled Clinical Psychologist to join our team at Dr. Kate Truitt & Associates A Psychological Corporation. As a leading private practice, we specialize in the treatment of adults with trauma and stress-related disorders.ResponsibilitiesProvide individual, couples, or group therapyCrisis intervention and case...


  • Pasadena, California, United States Huntington Hospital Inc Full time

    Job SummaryHuntington Hospital Inc is seeking a skilled Clinical Social Worker to join our team on a per diem basis. This role will provide case finding, consultation, and care management services to adults with disabilities and older adults in home and community-based settings.Key ResponsibilitiesAssess needs, monitor quality of care, and provide education,...


  • Pasadena, California, United States Huntington Hospital Inc Full time

    Job Title: Clinical Dietitian, Per DiemHuntington Hospital Inc is seeking a skilled Clinical Dietitian to join our team on a per diem basis.Job Summary:The Clinical Dietitian will be responsible for providing medical nutrition therapy, nutritional and dietary counseling, and conducting nutritional and dietary assessments. The ideal candidate will have a...


  • Pasadena, California, United States Kaiser Permanente Full time

    Job SummaryAs a Clinical Nursing Supervisor, you will provide first-line supervision at one site for nursing and other professional staff providing direct patient care. This may include home infusion programs, assessment or treatment clinics, and geriatric or other patient populations. You will be responsible for supervising the delivery of clinical...


  • Pasadena, California, United States Huntington Hospital Full time

    About Huntington HospitalHuntington Hospital is a nationally recognized healthcare leader with a commitment to providing equitable, high-quality care to all members of our community. We strive to create a place of belonging for our patients and employees, and we empower our team members to enact change that continuously improves our ability to deliver...


  • Pasadena, California, United States Huntington Hospital Full time

    OverviewHuntington Hospital, an affiliate of the Cedars-Sinai Health System, is seeking a full-time Palliative Care Physician to oversee a 16-year established consult service.The ideal candidate will have a strong background in Palliative Care, excellent communication skills, and a collaborative management style.ResponsibilitiesInitial consults with patients...


  • Pasadena, California, United States Albertsons Full time

    Job DescriptionAre you a pharmacy student looking to gain hands-on experience in a dynamic and patient-focused environment? Do you want to develop your skills in patient counseling, customer service, and clinical services? If so, we have an exciting opportunity for you to join our team as a Pharmacy Student Intern at Albertsons Companies.As a Pharmacy...


  • Pasadena, California, United States Huntington Hospital Inc Full time

    Job Summary:As a key member of the Huntington Hospital Inc team, the Manager, Nursing Talent Acquisition will be responsible for developing and implementing effective nursing and clinical recruitment strategies to meet the organization's business objectives. This role requires a strong understanding of the healthcare industry and the ability to source,...


  • Pasadena, California, United States i4 Search Group Full time

    Job SummaryWe are seeking an experienced Nurse Practitioner to join our team in Pasadena, TX. As a Primary Care Provider, you will be responsible for providing high-quality patient care, discussing patient symptoms and concerns, and performing thorough examinations to diagnose medical problems and prescribe medication or create treatment plans.Key...


  • Pasadena, California, United States Partners in Special Education Full time

    Job Summary:As a Speech and Language Therapist at Partners in Special Education, you will play a vital role in supporting students with communication and language needs. This position requires a skilled professional who can develop and implement effective intervention strategies, collaborate with school teams, and maintain professional records of assessment...


  • Pasadena, California, United States Superior Health Consulting Full time

    At Superior Health Consulting, we are seeking a skilled Medical Assistant to join our team. As a Medical Assistant, you will play a vital role in providing assessments for physicians and performing supplemental monitoring and optimized detection of cardiovascular, neurological, and metabolic conditions associated with adverse health events.Our product offers...

  • Youth Advocate

    1 month ago


    Pasadena, California, United States Bienvenidos Full time

    Job Title: Youth AdvocateHillsides is a premier provider dedicated to healing children and young adults, strengthening families, and transforming communities through quality comprehensive services and advocacy.Job Summary:We are seeking a highly motivated and compassionate Youth Advocate to join our team. The successful candidate will provide direct...

  • Account Manager

    4 weeks ago


    Pasadena, California, United States Mindera Health Full time

    About the Role:Mindera Health is seeking a highly motivated and experienced Account Manager to join our team in Southern California. As an Account Manager, you will be responsible for driving the adoption of our innovative diagnostic platform, Mind.Px, through effective relationship building with Dermatologists and Rheumatologists.Key Responsibilities:Engage...

  • Pharmacy Professional

    4 weeks ago


    Pasadena, California, United States Walgreens Full time

    Job SummaryWe are seeking a highly skilled Pharmacy Intern Grad to join our team at Walgreens. As a Pharmacy Intern Grad, you will be responsible for providing exceptional customer service, counseling patients on medication usage, and ensuring the proper compounding and dispensation of prescribed medications.Key ResponsibilitiesProvide pharmacy consulting...


  • Pasadena, California, United States Kaiser Permanente Full time

    Job Summary:This position plays a key role in the administration of the state-mandated Prenatal Screening Program within the Genetic Screening Services Department.The successful candidate will ensure compliance with the Prenatal Screening Program requirements as determined by the California Department of Health Services, Prenatal Screening Branch.Key...

  • Account Manager

    4 weeks ago


    Pasadena, California, United States Mindera Health Full time

    Job Summary: We are seeking a highly motivated and experienced Account Manager to join our team at Mindera Health. As a key member of our sales team, you will be responsible for driving the adoption of our innovative diagnostic platform, Mind.Px, through effective relationship building with Dermatologists and Rheumatologists in Southern California. Key...

  • Pharmacist Assistant

    4 weeks ago


    Pasadena, California, United States Kaiser Permanente Full time

    Job Summary:As a Pharmacy Technician at Kaiser Permanente, you will play a vital role in providing pharmaceutical care to our patients. Under the direct supervision of a licensed pharmacist, you will be responsible for dispensing, compounding, procuring, storing, and distributing pharmacy products. You will also consult with patients and medical personnel...

  • Account Manager

    4 weeks ago


    Pasadena, California, United States Mindera Health Full time

    About Mindera HealthMindera Health is a pioneering company in the field of precision and personalized diagnostic platforms. Our mission is to revolutionize the way patients, physicians, and payers approach skin diseases by providing a scalable and non-invasive biomarker extraction technology and data analytics platform.Job DescriptionWe are seeking a highly...