Registered nurse manager jobs in Torrance, CA

The Nurse Clinical Supervisor, UM Denial Compliance oversees the denial process within the utilization management (UM) department, ensuring that all denials are handled efficiently, accurately, and in full compliance with regulatory, accreditation, and health plan requirements. The role involves both leadership and compliance management functions. Key Responsibilities Supervise licensed and non-licensed denial unit staff, including work assignments, evaluations, and discipline. Collaborate with medical directors, physician reviewers, and other UM/PA teams to coordinate denial decisions. Maintain compliance with privacy and regulatory standards. Prepare and manage departmental reports, audits, and work plans. Conduct internal quality audits for the denial process. Develop and deliver staff education and training related to compliant denial correspondence. Monitor daily operations-such as productivity, turnaround times, and staffing. Stay current on state and federal regulations and implement necessary process adjustments. Lead process improvement and compliance initiatives aligned with company objectives. Serve as a resource for clinical and technical guidance across teams. Expected Pay RN Supervisor: Up to $120,000 annually. LVN Supervisor: Up to $106,000 annually. Salary depends on experience, licensure, skills, and market factors. We offer great benefits to our full-time employees: Health and wellness: Employer-paid medical, dental, and pharmacy coverage Vision, FSAs, EAP, and Behavioral Health services. Retirement and savings: 401(k) and income protection. Professional development: Tuition reimbursement, license renewal/CEU reimbursement. Work-life balance: Vacation, sick time, paid holidays, company celebrations, and a business-casual environment. Company Culture The organization emphasizes growth, teamwork, and advancement, offering a fast-paced but supportive environment where employee success contributes directly to company success. The Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

RN Nurse Manager of our Operating Room at Providence Little Company of Mary Medical Center in San Pedro, CA. This leadership position is Full-Time and will work 8-hour Day shifts. Accountable for the delivery of high quality nursing care and for the administrative management of multiple nursing units and/or FTE's over 80 on a 24 hour basis. Fulfills all duties and responsibilities associated with the unit manager position. Demonstrates proficiency in delivering care to assigned age specific patient population (e.g., infants, adolescents, adults, geriatrics, pediatrics), and participates in related continuing education. Providence Little Company of Mary Medical Center San Pedro, awarded the Joint Commission's Gold Seal of Approval and the American Heart Association/American Stroke Association's Gold Plus Achievement Award, is recognized for its exceptional stroke care. Additionally, our Rehab Center is nationally ranked by UDSMR and accredited by CARF for outstanding rehabilitation programs. Providence caregivers are not simply valued - they're invaluable. Join our team at Providence Little Company Of Mary San Pedro Hospital and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Required Qualifications: Bachelor's Degree or Bachelor's in progress. California Registered Nurse License upon hire. National Provider BLS - American Heart Association upon hire. 3 years - Recent clinical experience. Why Join Providence? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. About Providence At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. About the Team The Sisters of Providence and Sisters of St. Joseph of Orange have deep roots in California, bringing health care and education to communities from the redwood forests to the beach shores of Orange county - and everywhere in between. In Southern California, Providence provides care throughout Los Angeles County, Orange County, High Desert and beyond. Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care. Our not-for-profit network provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care, and even our own Providence High School. Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement. Requsition ID: 392563 Company: Providence Jobs Job Category: Nursing-Patient Facing Job Function: Nursing Job Schedule: Full time Job Shift: Day Career Track: Leadership Department: 7017 LCMSP OP SURGERY Address: CA San Pedro 1300 W 7th St Work Location: Providence Little Co of Mary Medical Ctr-San Pedro Workplace Type: On-site Pay Range: $73.44 - $115.94 The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. PandoLogic. Category:Healthcare, Keywords:Nurse Manager, Location:Anaheim, CA-92816

Coverage Needed: Pediatric homecare nurse with Gtube experience needed for 21 y/o patient Shifts: Thursday and Friday from7am - 7pm About the Role At Care Options for Kids, a pediatric home health care company providing one-on-one care in the home, we do things a little differently. There's no revolving door of patients or hospital setting chaos blinking call lights, scurrying doctors, and wards bursting at the seams. You work with self-sufficient autonomy, empowered to make a real difference in your clients' lives. We value your clinical knowledge and respect the deep one-on-one bond you establish with the families you care for. Benefits for Registered Nurses (RNs) Paid Time Off (PTO) and flexible schedule Medical, dental, and vision coverage 401(k) Weekly pay and direct deposit 24/7 on-call for support CEU credits Training opportunities Preceptor Program Nurse Referral Bonus Access to a simple, easy-to-use website that supports your everyday functions! Rack up Stars for cash-value rewards. We believe in recognizing a job well done! Discounts on movie tickets, car rentals, hotels, theme parks, and more! Responsibilities of Registered Nurses (RNs) Medication administration per physician orders Physician ordered treatments for: Nutrition via a feeding tube Tracheostomy care Suctioningnasal, oral and/or endotracheal Ventilation care Seizure assessment and treatment Requirements for Registered Nurses (RNs) Current, active Florida RN license Current BLS CPR card (obtained in-person, not online) G-tube, trach, vent experience, or willing to train TB Skin Test (PPD) or TB Blood Test (QF) Alzheimer's training - 2 Hour DOEA Approved Course (provided at no cost if needed) 1- Hour DOEA Alzheimer's Video (provided free of cost on DOEA website) About Care Options for Kids Care Options for Kids is the leading provider of pediatric nursing services. Our mission is to provide high-quality pediatric services that help children and families live their best lives. Achieving that mission can only be accomplished with talented and caring nurses like you. With locations in Colorado, Texas, Arizona, Nevada, Florida, Oregon, Washington, California, Wyoming, New Jersey, Delaware, and Pennsylvania, the Care Options for Kids Community offers a wide range of pediatric health services, including pediatric nursing and therapies, ABA therapy, nursing, Family Caregiver Services, and school-based services. #APPNUNAP #RDNUNAP Salary: $32.00 - $35.00 / hour

The Denials Case Manager, RN appeals all denials using InterQual criteria and medical necessity. Collaboratively works with all members of the revenue cycle team and all types of payers to resolve denials, maximize accurate and timely reimbursement, and perform reimbursement recovery and retention service. Evaluates, tracks and trends denials, and implements denial prevention programs. Works in collaboration with Case Managers, Physicians, Finance and multidisciplinary teams to ensure compliance with documentation and educates as needed. This position requires the full understanding and active participation in fulfilling the Mission of San Gabriel Valley Medical Center. It is expected that the employee will demonstrate behavior consistent with the Core Values. The employee shall support San Gabriel Valley Medical Center's strategic plan and the goals and direction of the Performance Improvement Plan (PIP). According to the American Case Management Association Standard of Practice, Case Management is expected to “advocate for the patient while balancing the responsibility of stewardship for their organization, and in general, the judicious management of resources.” Medicare defines Medical necessity as “health care services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.” Responsibilities Specific Job Duties: Ensures template for appeals includes reason for denial, diagnosis codes, MCG criteria used to support appeal, highlights of medical necessity supporting appeal, and only supporting documents necessary to support appeal are submitted with appeal template. Has knowledge of appeal deadlines and ensures appeals are submitted within this timeframe. Tracks responses to appeals, follows-up as appropriate. Working knowledge of levels of appeals, time lines, and contractual requirements related to appeals. Works with payers to resolve issues related to underpayments or increased denial trends. Ensures working knowledge of contracts to ensure appropriate reimbursement. Works closely with facility department directors such as Admitting, Case Management, Patient Accounting and CBO Directors to review, resolve and streamline all necessary aspects of the appeals process Establish appropriate tool for measuring Denial Tracking and Trending. Tracks and trends data, identifies opportunities for improvement, and establishes process improvement strategies as appropriate. Works closely with Case Managers regarding the Peer to Peer process for concurrent denials. Ensures they are completed within timeframes and logged. Creates a peer to peer report on weekly/monthly basis for presentation at denials meetings. May be asked to provide education and training to the Medical Staff, Nursing staff and or others related to denial prevention. Leads in RAC preparedness and assists facility in the time of RAC Audits. Participates in Continued Education in current laws that prevent unlawful denials, California Code of Regulations and HMO Compliance. Attends training and develops relevant knowledge and skills related to any identified gaps. Participates in all Corporate and Facility based Denials Meeting Participates in Utilization Management and other meetings regarding denials, and audits as necessary. Other responsibilities deems necessary as delegated. regarding denials and denials prevention Performs other duties as assigned. Qualifications Minimum Qualifications Graduate of an accredited RN School of Nursing BSN preferred Four years recent acute care experience in a critical care setting (preferred) Two years Utilization Management/Case Management experience Working knowledge of MCG, Intensity of Service/Severity of Illness criteria. Working knowledge of Title XXII and Title XIX. Working knowledge of reimbursement related to Medicare, Medi-Cal, Capitation, Shared Risk, and Managed Care. Ability to negotiate with the physicians, payers, and customers. Ability to track outcomes and report findings. Able to problem solve effectively. Ability to use clinical knowledge to identify potential quality issues. Provides proper notification of absence or tardiness within established departmental time frames. Licenses/Certifications Current California RN License Current BLS Card

Your Role The Care Management team coordinates, educates, and advocates care for the Dual-Special Needs (DSNP) population with Blue Shield of California. The Case Management - Nurse, Senior will report to the Manager of Care Management within Medical Care Solutions. In this role you will be responsible for managing a caseload of DSNP members, reviewing Health Risk Assessments and completing Individualized Care Plans, engaging members to reduce readmissions to the hospital, and supporting the DSNP care management team. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning. Your Knowledge and Experience Current CA RN License required Bachelor's of Science in Nursing or advanced degree preferred Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements Requires 5+ years' experience in nursing, health care or related field. 3+ years managed care experience preferred. Health insurance/managed care experience desired. Transitions of care experience preferred Excellent communications skills Your Work In this role, you will: Research and design treatment /care plans to promote quality of care, cost effective health care services based on medical necessity complying with contract for each appropriate plan type. Initiate timely individualized care plans (ICP) based on health risk assessment (HRA) completion, participation in and documentation of interdisciplinary meetings (ICT), assisting in transitions of care across all ages. Determine appropriateness of referral for CM services, mental health, and social services. Provide Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD). Conduct member care review with medical groups or individual providers for continuity of care, out of area/out of network and investigational/experimental cases. Manage member treatment to meet recommended length of stay. Ensure DC planning at levels of care appropriate for the members' needs and acuity Assess members' health behaviors, cultural influences and clients belief/value system. Evaluates all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriers. Research opportunities for improvement in assessment methodology and actively promote continuous improvement. Anticipates potential barriers while establishing realistic goals to ensure success for the member, providers and BSC. Determine realistic goals and objectives and provide appropriate alternatives. Actively solicit client's involvement. Design appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access, and cost-effective outcomes. Adjust plans or create contingency plans as necessary. Assess and re-evaluates health and progress due to the dynamic nature of the plan of care required on an ongoing basis. Initiates and implements appropriate modifications in plan of care to adapt to changes occurring over time and through various settings. Develop appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access, and cost-effective outcomes. Recognize need for contingency plans throughout the healthcare process. Develop and implement the plan of care based on accurate assessment of the members and current of proposed treatment.

Job Description: Care Manager - Registered Nurse Monogram Health is looking for skilled Registered Nurse eager for the opportunity to make a difference in patients' lives. The Care Manager RN is a key member of an integrated Care Team which includes an Advanced Practice Provider and a Social Worker. The patients we serve often struggle with multiple serious diseases. Registered Nurses help patients improve their quality of life in the home and slow the progression of kidney disease, enabling positive health outcomes. Your Impact: As a Registered Nurse, you are an integral part of building trusting relationships with patients, so that they can experience a high quality of life at home. Work with a small panel of patients where you can directly experience the impact of your care. In healthcare systems, the patient has too often become secondary due to processes and incentives that don't positively impact the patient for the long term. Here at Monogram, we strive to change that narrative by putting our patients and their quality of life at the forefront of what we do. Highlights & Benefits $100k starting salary Flexible scheduling with a hybrid and in-home model Competitive compensation and a performance-based bonus program Full benefits package including medical, dental, vision, life insurance, 401(k) plan with matching contributions, paid vacation and holiday time Roles and Responsibilities Work closely with patients' medical providers to develop and continually adapt care plan Perform in-home care management visits to execute care management plan Monitor biometric data and follow approved protocols for any necessary interventions Inventory and reconcile medications and coordinate with pharmacists and prescribers Perform patient health assessments and surveys as required Deliver individual and group education on CKD, ESRD, dialysis and associated comorbidities Encourage medication and treatment adherence through frequent contact with patients Engage family and social support groups in the education and care of patients Serve as the primary point of contact and be the first call when patients have questions (business hours) Provide education and coaching around medications, medical conditions, diet, exercise, and lifestyle choices Educate patients and facilitate conversations around proactive care decisions, especially relating to Advance Care Plans and ESRD treatment modalities Obtain vital signs when visiting patient and escalate any concerns to the provider Initiate patient relationships through enrolment and onboarding processes Perform post-op and hospital discharge visits to help patients through vulnerable transitions Review and document patient updates and progress in care management platform Coordinate with dialysis providers to ensure transitions of care are seamless Position Requirements Frequent local travel to perform in-home visits Basic Life Support (BLS) certification is required in this role. The company will support your certification completion through onboarding Infrequent domestic travel may be required, primarily to Brentwood, TN for training Self-starter with the ability to work independently with minimal supervision Ability to show empathy and quickly build relationships with patients and physicians Graduate of an accredited School of Nursing Currently licensed as a Registered Nurse in the State of the posted location 2+ years previous experience working in care management and/or with CKD/ESRD patients Ability to take call remotely on some nights and weekends Excellent verbal communication skills both in person and on the phone Familiarity with Microsoft Office and mobile phone and web-based applications About Monogram Health Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person's health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders. Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient's healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home. Monogram Health's personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum.

TYPE OF RECRUITMENT OPEN COMPETITIVE JOB OPPORTUNITY EXAM NUMBER Y5701F THIS ANNOUNCEMENT IS A REPOSTING TO UPDATE THE ESSENTIAL JOB FUNCTION TO EXAMPLES OF DUTIES AND UPDATE THE EXAMINATION CONTENT INFORMATION. FILING START DATE 8/10/2020 at 9:00 A.M. (PT) This examination will remain open until the needs of the service are met and is subject to closure without prior notice. DEFINITION: Consults with administrative, medical, and nursing personnel in hospitals, skilled nursing facilities, and related health facilities to assist them in achieving compliance with State and Federal nursing regulations, and with the professional staff of the County Health Facilities Inspection Division in evaluating nursing services provided by licensed health care facilities. ABOUT LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES The Los Angeles County Department of Health Services (DHS) is the second-largest municipal health system in the nation. Through its unified system of 23 health centers and four hospitals, as well as its expanded network of community partner clinics, DHS annually provides direct care to over 500,000 patients, employs more than 23,000 staff, and has an annual budget exceeding $8.4 billion. Through academic affiliations with the University of California, Los Angeles (UCLA), the University of Southern California (USC), and the Charles R. Drew University of Medicine and Science (CDU), DHS hospitals are training sites for physicians completing their Graduate Medical Education in nearly every medical specialty and subspecialty. In addition to its direct clinical services, DHS also runs the Emergency Medical Services (EMS) Agency and the County's 911 emergency response system, as well as Housing for Health and the Office of Diversion and Re-entry, each with a critical role in connecting vulnerable populations, including those released from correctional and institutional settings, to supportive housing. MISSION: Our mission is to enhance the health of our patients and communities by delivering exceptional care.EXAMPLES OF DUTIES: * Conducts audits, special studies, and critical reviews of clinical practices and process, to assess compliance with regulatory and legal mandates. * Collects data necessary for the evaluation of infection prevention and control efforts from various sources including the medical record, laboratory results, etc. * Acts as facility liaison for system wide programs focused on infection prevention and control. * Provides staff support to Infection Control, QI, Patient Safety, and Risk Management related committees. * Conducts surveys to measure clincal practice outcomes, and in consultation with stakeholders formulates solutions to improve outcomes. The survey process includes preparing survey questions, distributing surveys, following up on facility/program responses, and compiling and analyzing summary data. * Functions as a Just Culture expert to provide consultation to facilities in the use and interpretation of the Just Culture model. Provides facility training in Just Culture concepts when requested. * Assists with Risk Management and Patient Safety related functions, including staffing DHS' Risk Management and Patient Safety committees. * Provides professional consultation to health facility administrators and nursing staff in the interpretation of laws, regulations and standards governing licensing, accreditation and certification for Medicare and Medi-Cal and in various acceptable methods of maintaining, improving, or modifying nursing operations. * Plans, develops, and conducts orientation and in-service training sessions for Division staff, conducts and participates in educational programs for health facility administrators, nurses and other health professionals, and develops guidelines and manuals for use in interpreting requirements for nursing care services. * Conducts both internal and external surveys to determine standards of practice which includes preparing survey questions, distributing surveys, following up on facility/program responses, and compiling summary data. * Visits health facilities and evaluates the quality of nursing service and compliance with laws and regulations; Notifies facilities in writing of findings and recommendations for correction of deficiencies, monitoring progress toward implementation of recommendations. * Conducts audits, performs special studies and critical reviews of medical record, such as adverse event investigations, Joint Commission National Patient Safety Goal audits, and risk management audits to confirm compliance with facility enacted corrective actions. * Functions as the chairperson for the Infection Control Committee, Quality Improvement Committee and Emergency Preparedness Subcommittee, which includes assisting department managers and directors to organize, interpret, and present data for committee meetings; Plans agendas and prepares minutes for the monthly Quality Improvement and Infection Control committee meetings. * Assists in departmental improvement projects such as those related to hospital acquired pressure injuries, falls, workplace violence, etc. * Performs reviews and critical analyses of Safety Intelligence (SI) incident reports submitted by facility frontline staff, to assess for appropriateness and thoroughness based on departmental policies. Identifies and notifies DHS Risk Management staff of events that may meet external reporting criteria such as CDPH Adverse Events and/or those that are at high risk for litigation. * Updates and revises program materials, such as the "Patient Safety & Risk Management Handbook". Creates Patient Safety and Risk Management educational materials for facility staff. * Maintains liaison with State and Federal agencies and professional organizations in connection with the development, analysis and interpretation of legislative and regulatory material in the area of nursing and its application to licensed health care facilities. SELECTION REQUIREMENTS: Option I: Five (5) years of experience as a Registered Nurse including two (2) years of experience in an administrative*, Supervisory, or consultative* capacity. OR Option II: A Master's Degree in Nursing from an accredited college or university AND four (4) years of experience as a Registered Nurse including two (2) years of experience in an administrative*, supervisory, or consultative* capacity. LICENSE: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing. Please ensure the certificates and licenses section of the application is completed. Provide the type of the required license(s), the number(s), the date(s) of issue, the date(s) of expiration and the name(s) of the issuing agency for each license as specified in the Selection Requirements. Applicants claiming experience in a state other than California must provide their Registered Nurse License Number from that state on the application at the time of filing. Applications submitted without the required evidence of licensure will be considered incomplete. Required license(s) and/or certification(s) must be active and unrestricted, or your application will not be accepted. Additionally, in order to receive credit for license(s) and/or certification(s) in relation to any desirable qualifications, the license(s) and/ or certification(s) must be active and unrestricted. Successful applicants for positions that require driving must obtain and present a copy of his/her driving record from the California State Department of Motor Vehicles before final appointment. Applicants should not present a copy of their driving history until asked to do so by the hiring department. The County will make an individualized assessment of whether an applicant's driving history has a direct or adverse relationship with the specific duties of the job. License must not be currently suspended, restricted, or revoked. PHYSICAL CLASS: II - Light: Light physical effort which may include occasional light lifting to a 10-pound limit, and some bending, stooping or squatting. Considerable walking may be involved. SPECIAL REQUIREMENT INFORMATION: * Administrative capacity is defined as performing in an administrative services branch of an organizational unit, including responsibility for the development of procedures and participation in policy formulation. Supervisory capacity is defined as planning, assigning, reviewing the work of staff, and evaluating employee performance. * Consultative capacity is defined as an expert in a specialized field, expressing views, providing opinions, and recommending courses of action to be taken on problems presented by others for resolution. In order to receive credit for any college course work, or any type of college degree, such as master degree, you must include a legible copy of the official diploma or official transcripts which shows the area of specialization with your application at the time of filing or within 15 calendar days of filing. DESIRABLE QUALIFICATIONS: Additional credit will be given to applicants who possess the following desirable qualifications: * Experience working as a Registered Nurse in a Risk Management, Quality Improvement, Patient Safety or Infection Control department. * Experience as a Registered Nurse surveying, investigating, inspecting and evaluating hospitals, skilled nursing facilities and other health facilities, clinics and/or individual providers for conformity with and enforcement of Federal and State licensing and certification requirements relating to the quality of medical care. EXAMINATION CONTENT: This examination will consist of an evaluation of education and experience based upon application information, desirable qualifications, and supplemental questionnaire, weighted at 100%. Candidates must meet the selection requirements and achieve a passing score of 70% or higher on this examination in order to be placed on the eligible register. ELIGIBILITY INFORMATION: Applications will be processed on an "as received" basis and those receiving a passing score will be promulgated to the eligible register in the order of their score group for a period of twelve (12) months following the date of eligibility. No person may compete in this examination more than once every twelve (12) months. AVAILABLE SHIFT: Appointees may be required to work any shift, including evenings, nights, weekends and holidays. VACANCY INFORMATION: The resulting eligible register for this examination will be used to fill vacancies throughout the Department of Health Services as they occur. APPLICATION AND FILING INFORMATION: Applications must be filed online only. Applications submitted by U.S. mail, Fax, or in person will not be accepted. Applications electronically received after 5:00 p.m., PT, on the last day of filing will not be accepted. Apply online by clicking the "APPLY" green button at the top right of this posting. You can also track the status of your application using this website. The acceptance of your application depends on whether you have clearly shown that you meet the SELECTION REQUIREMENTS. Fill out your application and supplemental questionnaire completely to receive full credit for related education and/or experience in the spaces provided so we can evaluate your qualifications for the job. Please do not group your experience, for each position held, give the name and address of your employer, your position title, beginning and ending dates, number of hours worked per week, and description of work performed. If your application is incomplete, it will be rejected. IMPORTANT NOTES: * Please note that All information supplied by applicants and included in the application materials is subject to VERIFICATION. We may reject your application at any point during the examination and hiring process, including after an appointment is made. * FALSIFICATION of any information may result in DISQUALIFICATION. * Utilizing VERBIAGE from Class Specification and/or Selection Requirements serving as your description of duties WILL NOT be sufficient to demonstrate that you meet the requirements. Comments such as "SEE RESUME" or "SEE APPLICATION" will not be considered as a response; in doing so, your application will be REJECTED. * It is recommended that you provide your work experience using statements that provide the following three elements: ACTION you took, the CONTEXT in which you took that action, and the BENEFIT that was realized from your action. Include specific reference to the impact you made in the positions you have held. NOTE: If you are unable to attach documents to your application, you must email the documents to the Exam Analyst, Sylvia Jaimez at ************************ within 15 calendar days of filing online. Please ensure to reference your attachment(s) by including your full name, examination number and examination title in the subject of your email. SOCIAL SECURITY NUMBER LANGUAGE: Please include your Social Security Number for record control purposes. Federal law requires that all employees have a Social Security Number. COMPUTER AND INTERNET ACCESS AT PUBLIC LIBRARIES: For candidates who may not have regular access to a computer or the internet, applications can be completed on computers at public libraries throughout Los Angeles County. NO SHARING USER ID AND PASSWORD: All applicants must file their applications online using their own user ID and password. Using a family member or friend's user ID and password may erase a candidate's original application record. FAIR CHANCE INITIATIVE The County of Los Angeles is a Fair Chance employer. Except for a very limited number of positions, you will not be asked to provide information about a conviction history unless you receive a contingent offer of employment. The County will make an individual assessment of whether your conviction history has a direct or adverse relationship with the specific duties of the job, and consider potential mitigating factors, including, but not limited to, evidence and extent of rehabilitation, recency of the offense(s), and age at the time of the offense(s). If asked to provide information about a conviction history, any convictions or court records which are exempted by a valid court order do not have to be disclosed. ADA COORDINATOR: ************** CALIFORNIA RELAY SERVICES PHONE: ************** DEPARTMENT CONTACT: Sylvia Jaimez, Exam Analyst Telephone Number: ************** Email Address: ************************

Job Description Voted one of the best companies to work for by Modern Healthcare Magazine: Renew Health Consulting Services is an award winning family company providing healthcare services including skilled nursing, assisted living and senior living communities. We believe that seniors are extraordinary people. Their lives are filled with achievements, contributions and wisdom. They have raised families, served their communities and country, lived history and ultimately set the stage for us. We are honored to provide their care, as they make the transition to the golden years, and when it becomes more challenging to care for one's self. From a short-term rehabilitation stay to long term nursing care, each of our clinical programs are designed to reduce hospitalizations so our patients can focus on achieving their individual care plan goals whether it's returning home or staying with us for their long term care needs Our commitment to superior quality of life is evident when you visit our family of centers. At our care center you will meet compassionate and professional team members who understand that finding the right skilled nursing setting and long-term care option could be difficult and confusing and are wanting to make a difference by providing the utmost care to genuinely help our patients and the community around them. If this sounds like a great fit for you, we would love to have you join our wonderful team! Compensation & Benefits: As a growing and essential company, we have many opportunities for growth and development within the medical industry and are committed to providing the resources and training you need. Pay is market competitive and negotiable based on your experience. Full-time employees will be eligible for a variety of comprehensive medical, dental, and vision insurance plans. Full-time employees will be eligible for Tuition Assistance. 401K. Travel Allowance The anticipated pay range for candidates who will work in California is $150K to $180K annually . The offered pay to a successful candidate will be dependent on several factors that may include but are not limited to years of experience within the job, years of experience within the required industry, education, etc. We are looking for full-time RN MDS Consultant Responsibilities: Responsible for visiting facilities in the assigned Region(s) on a regular basis and ensuring the accurate and timely submission of patient assessments, care planning, and billing processes that comply with the Patient-Driven Payment Model (PDPM). Conduct comprehensive assessments of patient's clinical needs and identify potential PDPM coding opportunities. Collaborate with interdisciplinary teams to develop patient-centered care plans that optimize clinical outcomes and maximize reimbursement under PDPM. Analyses and organizes PDPM and case mix data to ensure appropriate utilization of resources. Review medical documentation to ensure completeness, accuracy, and compliance with CMS regulations. Monitor and analyze PDPM-related data, including patient outcomes, revenue, and compliance metrics, and provide regular reports to senior leadership. Coordinate with MDS to ensure accurate completion of all MDS assessments and any supporting assessments or clinical documentation. Ongoing QA of medical records for the presence of supporting documentation for all items coded on the MDS. Provide education and training to staff on PDPM and related topics, including coding, documentation, and care planning Serve as a subject matter expert on PDPM to internal and external stakeholders, including regulatory bodies, payers, and auditors. Participate in quality improvement initiatives to enhance patient care and optimize reimbursement under PDPM. Maintain up-to-date knowledge of PDPM regulations and industry best practices and share this information with the facility and management. Qualifications: Bachelor's degree in nursing or related clinical field Active RN license or relevant clinical licensure. Experience with MDS completion preferred. Minimum of 3-5 years of clinical experience in a healthcare setting. Experience with Federal Medicare Skilling and Long term care billing. In-depth knowledge of the PDPM reimbursement system and CMS regulations. Submit your application and join our award-winning team! We are an equal opportunity employer and we are committed to Equal Employment Opportunity regardless of race, color, national origin, gender, sexual orientation, age, religion, veteran status, disability, history of disability or perceived disability, and per the Fair Chance Ordinance will consider qualified applications with criminal histories in a manner consistent with the ordinance. INDHP

The Martin Luther King Jr. Behavioral Health Center (MLK BHC) is a program of HealthRIGHT 360 and is contracted with the Department of Public Health's Substance Abuse Prevention and Control (SAPC) program. MLK BHC offers residential Drug Medi-Cal (DMC) services for a maximum of 99 adult individuals, comprising 33 beds each for judicially involved men, men, and women. MLK BHC collaborates closely with other Behavioral Health Center programs to ensure a comprehensive range of services for low-income and Medi-Cal-eligible individuals. Situated on the Martin Luther King Jr. Hospital campus in the Willowbrook area of South Los Angeles, the program serves residents of all Los Angeles County. The Nurse Manager ensures provision of quality client care and effective team performance by incorporating the organization's mission, vision, and values as part of our service delivery. They ensure efficient nursing operations and provides supportive work environment for staff through facilitation of training programs, monitoring and ensuring compliance with regulatory requirements, creating and implementing policies and procedures, managing staff, facilitating effective communication, interdisciplinary collaboration, and team meetings to promote client-centered care, and by performing other tasks to ensure that services are delivered with compassion, respect for diversity, and adherence to ethical standards. KEY RESPONSIBILITIES People Management Interview, select, hire, and terminate employees in collaboration with Human Resources. Supervise direct reports and service staff. Ensure that all direct reports follow HealthRIGHT 360's policies, procedures, position expectations, performance goals, and contractual requirements. Provide ongoing feedback, coaching, support, and conduct formal performance evaluations in a timely manner. Identify direct reports' strengths and weaknesses and strive to develop each team member to their fullest potential. Deliver and arrange training and resources to ensure that direct reports are successful in their roles. Ensure proper coverage of the program by creating work schedules and approving time away from work. Deliver all communications necessary to all team members to remain current with HealthRIGHT 360's policies and procedures and to inform them on quality-of-care concerns. Clinical Oversight Provide clinical and administrative oversight of all nursing treatment services. Ensure that clinical activities align with the organizational mission, vision, strategy, and policies, regulatory requirements, program requirements, and contractual obligations. Ensure timely completion of documentation and adherence to program requirements. Collaborate with medical, mental health, and substance abuse staff to ensure coordinated care. Ensure control and oversight of any paper prescriptions. Coordinate pharmacy services. Ensure lab orders are carried out within 14 days and that lab results are reviewed, and critical values are reported to the provider. Ensure charts meet quality management standards per monthly utilization review and/or chart review process, including completion of review tools within designated timeframe. Direct Service Provide medication education consultations and collaborations. Assume ownership of crisis situations and ensure proper documentation and service delivery. Provide direct service within the scope of practice. Assist the Medical Director with medication management of patients. Maintain and monitor medication sheets to ensure patient adherence to prescribed medications. Triage client's medical concerns. Provide education and counseling to clients on care and medication management. Administrative and Other Duties Develop and maintain relations with contractors, other team members, and community providers to ensure program and treatment continuation. Facilitate team meetings and case conferences to support client care and staff development. Create, review, recommend, and implement policies and procedures related to health and wellness. Complete all assigned training in a timely manner. QUALIFICATIONS Education, Certification, or Licensure Bachelor's degree in Nursing or equivalent from an accredited institution. Active California Registered Nurse licensure. Valid BLS certification. Valid California Driver's License and access to registered and insured transportation. Experience At least seven years' nursing experience preferably in ambulatory care, public, or community health. At least three years' experience as a supervisor in a behavioral or mental health clinic or community health center. Experience working with clients/patients with co-occurring disorders preferred.

*5 years WC Examiner experience *Medical understanding to find treatment plans *Must be available continually during disgnated work hours *Abliity to follow pre-established medical protocols *Strong verbal and written communication skills *Eastside of WA (Ideally, tri-cities) *Relational personality is a must *Bilingual (Spanish) is a plus *Manage nurses and staff clients accordingly Salary will be discussed during interview *Bonus *Excellent pay *Excellent benefits

Skyline Med Staff Home Health is seeking a travel nurse RN Home Health for a travel nursing job in Torrance, California. Job Description & Requirements Specialty: Home Health Discipline: RN Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel Weekly amount stated in the job postings is estimated based on estimated hourly wages and potential stipends available for the location of the assignment. Pay package is calculated on bill rate at the time job was posted, but can change or vary without notice. Exact pay packages might vary as this is an estimate. Our recruiter would be happy to build an exact pay package for you for each job. Skyline Med Staff Home Health Job ID #35148482. Pay package is based on 8 hour shifts and 40.0 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN:Home Health,07:00:00-15:00:00 About Skyline Med Staff Home Health Join the Top- Rated Travel Healthcare Team! Skyline Med Staff was named as the #1 Best Travel Healthcare Company in 2025 by BluePipes, a recognition driven by glowing reviews from travel healthcare professionals. Our recruiters are consistently praised on Google for their responsiveness, dedication, accessibility, and industry knowledge. Ready to experience the difference? Apply for a job today and see why healthcare professionals choose Skyline! Certified Women Owned Business We believe that travel is good for the soul. We want to be on your journey with you and find the right job that fits you Skyline Med Staff is committed to one vision..... treating others the way that THEY want to be treated. The executive team at Skyline Med Staff focuses on a commitment to quality, consistency, and the highest level of service. Our team members continually strive to build long term relationships that center on you and helping you achieve your goals. Some of the Benefits you will receive with Skyline Med Staff: Over 30 years of combined experience in the staffing industry Higher Take-Home Pay Rates Dedicated Personal Recruiter We are available to you 24/7 Health Insurance Plan Options Tax Free Per Diems, Housing Stipends and Travel Reimbursements Joint Commission Certified Contracts in all 50 states Referral and Loyalty Bonuses Benefits Medical benefits Referral bonus

Job DescriptionBenefits: 401(k) 401(k) matching Company parties Competitive salary Flexible schedule Health insurance Paid time off Newport Hospice, is looking for dedicated health care professionals to join our ever-growing team!!! Help our team provide compassionate care to the patients in our community offering the best care programs available in the Orange County and Greater Los Angeles area. Become part of a team that strives to be a leader in providing professional and comprehensive care to critically, chronically and terminally ill patients in our community. Requirements of Hospice: Current RN license in State of CA One year of experience preferred Minimum one year of case management experience preferred Experience in hospice preferred Hospice RN Duties Include: Ensure quality and safe delivery of Hospice services Implements current nursing practices and provide direct hands-on care within scope of practice Obtains orders as needed to promote comfort and quality of life Keep Case Manager informed of all changes in condition and orders obtained Attend daily patient review meetings & bi-monthly Interdisciplinary meetings For assistance in applying for a position with Infinite Care Hospice, please contact ************** or **************************

Sign on Bonus: $2000. Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Preferred locations: Seattle, WA, Denver, CO, Las Vegas, NV or Woodland Hills, CA or Costa Mesa, CA. "Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law." Hours: Monday - Friday 9:00am to 5:30pm with 1-2 late evenings 11:30am to 8:00pm depending on your time zone. * This position will service members in different states; therefore, Multi-State Licensure will be required. The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically. How you will make an impact: * Ensures member access to services appropriate to their health needs. * Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. * Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. * Coordinates internal and external resources to meet identified needs. * Monitors and evaluates effectiveness of the care management plan and modifies as necessary. * Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. * Negotiates rates of reimbursement, as applicable. * Assists in problem solving with providers, claims or service issues. * Assists with development of utilization/care management policies and procedures. Minimum Requirements: * Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * Current, unrestricted RN license in applicable state(s) required. * Multi-state licensure is required if this individual is providing services in multiple states. Preferred Capabilities, Skills and Experiences: * Case Management experience is preferred. * Certification as a Case Manager is preferred. * Minimum 2 years' experience in acute care setting is preferred. * Managed Care experience is preferred. * Ability to talk and type at the same time is preferred. * Demonstrate critical thinking skills when interacting with members is preferred. * Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly is preferred. * Ability to manage, review and respond to emails/instant messages in a timely fashion is preferred. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $76,944 to $126,408. Locations: Colorado; Nevada; Washington State; California. In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

About TRIUNE Health Group TRIUNE Health Group is a nationally recognized managed healthcare company with over 35 years of experience. As a mission-driven, second-generation family-owned business, we are dedicated to improving lives by reducing the impact of injuries, enhancing health and wellness, and lowering healthcare and workers' compensation costs. At TRIUNE, we believe that every team member is essential to our success. We foster a supportive and collaborative environment where employees are valued, empowered, and provided with the tools they need to thrive-both professionally and personally. Why Join TRIUNE Health Group as a Nurse Case Manager? Be part of a well-established, family-owned company that prioritizes people over profits. Experience our culture of People Helping People , where every team member is treated with dignity and respect. Enjoy the stability, support, and resources needed to succeed while maintaining a healthy work-life balance. Perks & Benefits: Generous Time Off: 20 days of vacation plus 8.5 paid holidays Retirement Savings: 401(k) match to help you plan for the future Comprehensive Insurance: Medical, dental, and vision coverage Disability Coverage: Short-Term (STD) and Long-Term Disability (LTD) insurance Employee Support: Employee Assistance and Referral Program Work-from-Home Essentials: Home office equipment, including a laptop and desktop monitor Travel Perks: Mileage and travel reimbursement TRIUNE Health Group is an equal opportunity employer and a values-driven organization. Compensation is competitive and commensurate with experience. I. Summary of Position: The Nurse Case Manager coordinates resources and creates flexible, cost-effective options for catastrophically or chronically ill or injured individuals to facilitate quality, individualized, holistic treatment goals, including timely return to work when appropriate. II. Essential Duties and Responsibilities: Provide medical case management to individuals through coordination with the patient, physicians, other health care providers, the employer, and the referral source. Utilize the steps of Case Management to provide assessment, planning, implementation, evaluation, and outcome of an individual's progress. Evaluate individual treatment plans for appropriateness, medical necessity, and cost-effectiveness. Facilitate care, such as negotiating and coordinating the delivery of durable medical equipment and home health services, ensuring clear communication. Assess rehabilitation facilities for appropriateness of care, facilitate transportation, and coordinate architectural assessments of patients' homes when required. Communicate medical information clearly and compassionately to patients and families. Stay current with medical terminology and the federal and state laws related to health care, Workers' Compensation, ADA, HIPAA, FMLA, STD, LTD, SSDI, and SSA. Utilize technology (computer, cell phone, fax, and scanning machine) to prepare organized, timely reports while complying with safety rules and regulations in conjunction with HIPAA. Research medical and community resources for individuals with catastrophic or chronic diagnoses, such as but not limited to AIDS, cancer, spinal cord injuries, diabetes, head injuries, back injuries, hand injuries, and burns, ensuring accessibility for individuals. Possess a valid driver's license with the ability to travel 90% of the time. Perform other duties as assigned. III. Job Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Skills and Abilities: Proven leadership skills. Excellent verbal and written communication skills, including the ability to interact effectively with patients, customers, and fellow employees via phone, email, in-person, and formal presentations. Methodical in accomplishing job-related goals. Strong analytical and organizational skills, including the ability to multitask with attention to detail. In-depth knowledge of multi-software packages, notably Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) and the Internet. Maintain a friendly, professional attitude at all times. Exercise initiative and be solution-oriented, while keeping management up-to-date on current situations or opportunities. Dependability and adaptability. Education and Experience: Graduate of an accredited school of nursing. Current RN licensure in the state of operation. Fluency in English (speaking, reading, and writing). Three or more years of recent clinical experience, preferably in trauma, psychology, emergency, orthopedics, rehabilitation, occupational health, and neurology. CCM preferred. Certificates, Licenses, Registrations: While not mandatory, individuals with one or a combination of the following certifications are preferred: COHN, COHN-S, and CDMS. IV. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The base salary range/hourly rate listed is dependent on job-related, non-discriminatory factors such as experience, education, and skills. This position is also eligible for incentive compensation awards. You may be eligible for the following competitive benefits: medical, dental, vision, life, accident & disability, short and long-term disability, paid holidays, paid time off and 401 (k). bination of the following certifications is preferred: COHN, COHN-S, CCM, and CDMS.

Prior Authorization Temp Nurse Case Manager, RN Northridge, CA 4\-Month Contract Assignment Quick On\-Boarding\/Placement Process Career Stepping Stone from Bedside Nursing to Case Management (acute care experience and working knowledge of pre\-auth process required) Description The role of the Prior Authorization Nurse Case Manager (PACM) is to promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization specialty referral requests. The PACM will review for appropriate care and setting, and following guidelines\/policies, will approve services when indicated. If not indicated, PACM will forward requests to the appropriate physician or medical director with recommendations for other determinations, ensuring that the member is receiving the appropriate quality care in a preferred setting, while making sure regulatory guidelines are followed. 1. Understand, promote and review with the principles of medical management to facilitate the right care at the right time in the right setting. 2. Communicate effectively and interact with providers, staff and health plans daily regarding medical management and referral authorization issues. 3. Maintain a working relationship with PACM colleagues, the pre\-auth coordinator team, high\-risk nurse case managers, inpatient nurse case managers, medical directors, and network management. 4. Research alternative care plans and when necessary, assist in the routing of members to the most appropriate care\/setting, in order to provide right care\/right setting. 5. When necessary, act as liaison between the case managers, UM coordinators, contracted providers (PCPs\/specialists\/ancillary), and the members\/families. 6. Perform case reviews base on key screening outpatient indicators, and evaluate the PCP submitted plan of care for its completeness of documentation, consistency of treatment with medical groups clinical practice guidelines, adherence to standard evidence\-based or consensus guidelines, and health plan and CMS guidelines and\/or medical policies. 7. Maintain regulatory Turnaround Time Standards per regulatory guidelines. 8. Document accurately and completely all necessary information in authorization notes. 9. Understand all applicable capitation contracts and how they apply to review duties. 10. For those PACMs involved in DME, understand the contracts, and need to review rental vs. purchase approvals, and continued use so that equipment is picked up when needed. 11. When appropriate, coordinate and review for medical necessity and appropriate utilization any ancillary professional services, i.e. (home health, infusion, PT, OT, ST, etc.). 12. Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner. 13. Participates in “service recovery” through follow\-up with an upset patient or provider, gathering information, and demonstrating empathy. 14. Identifies network needs and report to management for potential contracting opportunities. Qualifications 1.Graduate from an accredited Registered Nursing Program 2.Current California RN License 3.Minimum of 1 year acute experience 4.Knowledge of Managed Care preferred. 5.Knowledge of NCQA, CMS, HSAG, and health plan requirements related to utilization management. 6.Knowledgeable with the pre\-authorization process and workflow, with prior authorization experience preferred. 7.Knowledgeable in computers and MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point). 8.Ability to deal with responsibility with confidential matters 9.Ability to work in a multi\-tasking, fast\-paced, high\-stress environment. Compensation $38\-$42\/Hr Negotiable based on experience "}}],"is Mobile":false,"iframe":"true","job Type":"Temporary","apply Name":"Apply Now","zsoid":"59877574","FontFamily":"PuviRegular","job OtherDetails":[{"field Label":"Industry","uitype":2,"value":"Health Care"},{"field Label":"Work Experience","uitype":2,"value":"1\-3 years"},{"field Label":"Salary","uitype":1,"value":"$38\-$42\/Hr"},{"field Label":"City","uitype":1,"value":"Northridge"},{"field Label":"State\/Province","uitype":1,"value":"California"}],"header Name":"Prior Authorization Temp Nurse Case Manager","widget Id":"**********00072311","is JobBoard":"false","user Id":"**********02463003","attach Arr":[],"custom Template":"5","is CandidateLoginEnabled":false,"job Id":"**********00327001","FontSize":"15","location":"Northridge","embedsource":"CareerSite","indeed CallBackUrl":"https:\/\/recruit.zoho.com\/recruit\/JBApplyAuth.do"}

Large and traveler friendly facility in Southern California is needing help in their Case Manager Team. Must have at least 2 year of experience, and are certified BLS and CA license are needed! Call Ventura Medstaff today for more details at ************.

Nurse Manager - Case Management, Float Pool, & Staffing Administration - (10033192) Description Join the transformative team at City of Hope, where we're changing lives and making a real difference in the fight against cancer, diabetes, and other life-threatening illnesses. City of Hope's growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and treatment facilities in Atlanta, Chicago, and Phoenix. our dedicated and compassionate employees are driven by a common mission: To deliver the cures of tomorrow to the people who need them today. City of Hope Lennar Foundation Cancer Center seeks a capable Nurse Manager to ensure efficient operations and workflows for the hospital, patient placement, and nursing policies needed to bring the hospital online. Once the hospital is open, this position will transform, and the Nurse Manager will be responsible for overseeing the house supervisors, patient safety, and daily hospital operations building and enhancing relationships through customer relations and appropriate professional involvement. The manager will work closely with multidisciplinary teams to develop services and ensure quality. As a successful candidate, you will:Assure satisfaction of patients, physicians and other customers with care and services that are delivered. Develop and foster collaborative relationships with other departments to support safe and high-quality patient care and services. Promote the implementation of evidence-based practices in delivery of patient care. Support and facilitate critical thinking of staff. Develop, maintain, and monitor staffing plans for assigned areas to ensure needs are met. Participates in recruitment and maintains adequate numbers of competent staff to provide care and meet patient care standards. Facilitate the orientation of new staff and the continuing education and professional development of existing staff. Assure staff have current licenses, certifications and are competent to provide care. Manage and lead staff to develop collaborative working relationships within department and with other departments as applicable. Collaborates with human resources to provide counseling or performance improvement of staff as needed. Support and develop the staff to ensure availability to participate in shared governance at the unit and organizational level. Assist nursing and practice leadership in managing and implementing departmental programs and goals that support the strategic plan for the organization and for patient care services. Support departmental implementation of new technology, services, and ongoing improvement. Effectively communicate (written & oral) across the organization. Performs other related duties as assigned or requested. Qualifications Your qualifications should include: Bachelor of Science in Nursing (or BSN not required if holds MSN) Minimum of 3 years of experience in an area of expertise relevant to the department with demonstrated progressive leadership growth California RN license (must obtain within 6 months of hire) American Heart Association-Basic Life Support (BLS) National Certification (must be acquired within 12 months of hire or transfer) Chemotherapy/Biotherapy certification preferred City of Hope employees pay is based on the following criteria: work experience, qualifications, and work location City of Hope is an equal opportunity employer. To learn more about our Comprehensive Benefits, please click here Primary Location: United States-California-IrvineJob: NursingWork Force Type: OnsiteShift: DaysJob Posting: Dec 19, 2025Minimum Hourly Rate ($): 63. 200600Maximum Hourly Rate ($): 105. 544800

Voca Healthcare is seeking a travel nurse RN Case Management for a travel nursing job in Mission Viejo, California. Job Description & Requirements Specialty: Case Management Discipline: RN Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel Benefits available on 1st of the month after start: Holiday pay Weekly pay Retention bonus 401k retirement plan Medical benefits Dental benefits Vision benefits Referral bonus Voca Healthcare Job ID #17452151. Pay package is based on 8 hour shifts and 40.0 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN:Case Manager,08:00:00-16:00:00 About Voca Healthcare As a Voca Traveler, you will gain new clinical skills, visit amazing places and meet awesome healthcare professionals. As a travel health professional, your experience and dedication to patient care is in high demand throughout the United States. Whether you are a veteran traveler looking for your next opportunity, or you are looking to travel for the first time, Voca is here to support you. Voca's experienced and dedicated travel team works in concert with you every step of the way. Our long-standing partnerships with some of the most respected and recognized healthcare organizations in the country allow us to identify career opportunities to help you increase your knowledge and experience while working with some of the best physicians and healthcare professionals in the world. At Voca, we strongly believe a better career results in a happier you. We are here to help you find a position that is professionally and personally rewarding. Benefits Holiday Pay 401k retirement plan Medical benefits Dental benefits Vision benefits Retention bonus Guaranteed Hours

Company DescriptionJobs for Humanity is partnering with CEDARS-SINAI to build an inclusive and just employment ecosystem. Therefore, we prioritize individuals coming from the following communities: Refugee, Neurodivergent, Single Parent, Blind or Low Vision, Deaf or Hard of Hearing, Black, Hispanic, Asian, Military Veterans, the Elderly, the LGBTQ, and Justice Impacted individuals. This position is open to candidates who reside in and have the legal right to work in the country where the job is located. Company Name: CEDARS-SINAI Job Description The RN Clinical Operations Supervisor supports the physician and clinical staff in the delivery of health care by performing operational oversight responsibilities, human resource responsibilities, as well as patient care assessments, and a variety of medically related tasks. The Supervisor is a registered nurse who works in an administrative role in an ambulatory care setting and performs both administrative duties and clinical services as needed or requested. Duties and Responsibilities: Coordinates all administrative (front and back office) clinical functions of the medical practice. Ensures a proficient back office workforce and assesses clinical staff for proficiency. Coordinates and maintains the needed staff certifications and licensing requirements. Assists in the development, review, and revision of standard operating policies and procedures in collaboration with senior management. Oversees and as needed, performs administrative functions which can include answering and triaging telephone calls for patient care matters, functioning as a liaison between physicians, the patients and the staff. Coordinates or serves as a liaison for administrative support activities including facilities management, pharmacy, utilization management, quality management, risk management, human resources, payroll, clinical services, and systems support. Controls wage and non-wage expenses, including pharmacy and medical supplies, in accordance with budgetary guidelines. Works in a collaborative role with the management team, staff, and physicians in the clinical practices, as well as related departments throughout the organization. Function as a key point person in research, setup, and implementation of new procedures, projects, initiatives, workflows, equipment. Prepare charts as needed and verifies that all pertinent items are available to the provider before patient care commences. Sets up exam room/procedure rooms appropriately based on visit needs. Assist providers in examination/procedure rooms as needed. May fulfill back-office staff functions including managing patient flow, charting, room prep, vitals, updating and maintaining medical records and handling designated clinical care telephone interactions. As advised by the provider may perform designated diagnostic tests, draw, prepare designated lab work and/or specimens. Administer immunization, injections, oral, or IV medications. Convey lab results to patients. Assist in follow-up scheduling needs. Answer patient calls and communication significant clinical findings to the provider. Serves as an advocate for the patient and uses appropriate resources. Education: Bachelor's degree in Nursing required. License/Certification: California RN state license required. Basic Life Support (BLS) from American Heart Association or American Red Cross required. Experience: Three (3) years of experience in a medical setting (i.e.: Emergency Room, Urgent Care) required. Leadership experience highly preferred. Working Title: RN, Clinical Operations Supervisor - Urgent Care Department: Operations Business Entity: Cedars-Sinai Medical Care Foundation Job Category: Nursing Job Specialty: Nursing Position Type: Full-time Shift Length: 8 hour shift Shift Type: Day Base Pay:$100,300.00 - $160,400.00