Nurse Specialist II

7 days ago


Los Angeles, California, United States L.A. Care Health Plan Full time
Job Summary

The 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) assessments, Focused Reviews, Interim Onsite Reviews, Consultation/Educational Site visits, Investigative visits, and/or other appropriate site visits to guarantee adherence to regulatory standards.

Key Responsibilities
  • Conduct audits utilizing Department of Health Care Services (DHCS) FSR/MRR/PARS tools, providing pre-audit and/or post-audit educational sessions.
  • Issue Corrective Action Plans (CAPs) and provide assistance or follow-up in implementing adequate corrections on-site.
  • Provide health education materials and clinical tools to facilitate improved screening, preventive care, and chronic disease management, promoting clinical quality improvements in practices.
  • Act as the Provider Quality Improvement Liaison (PQIL) to assess and communicate issues and improvement opportunities identified during the physician site visit.
  • Communicate and coordinate information and findings from site visits between FSR Manager, internal and external staff, and provider sites, documenting discussions and correspondence in the FSR file as necessary.
Requirements
  • At least 5 years of clinical experience, including Emergency Room (ER)/Acute care nursing or outpatient setting.
  • Registered Nurse (RN) - Active, current, and unrestricted California License.
  • Must obtain and maintain successful completion of a DHCS Certified Site Reviewer certification within 8 months of date of hire in the position.
Preferred Qualifications
  • Medi-Cal managed-care auditing experience.
  • At least one (1) year experience in Quality Improvement and/or familiar with DHCS audit tool.
Benefits

L.A. Care offers a wide range of benefits, including Paid Time Off (PTO), Tuition Reimbursement, Retirement Plans, Medical, Dental, and Vision, Wellness Program, and Volunteer Time Off (VTO).

Location

Los Angeles


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