Utilization review nurse jobs in Stanford, CA - 307 jobs

Olaro is seeking a travel nurse RN Labor and Delivery for a travel nursing job in Antioch, California. Job Description & Requirements Specialty: Labor and Delivery Discipline: RN Duration: 13 weeks 36 hours per week Shift: 12 hours, nights Employment Type: Travel PHP Job ID #466923. Pay package is based on 12 hour shifts and 36 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Labor & Delivery (LD) - Critical Need About Olaro Olaro Company Description Olaro is a trusted partner in healthcare staffing, connecting nurses and allied health professionals with opportunities nationwide. For over 35 years, we've helped clinicians expand their horizons by matching them with assignments that fit their lifestyle, career goals, and personal ambitions. At Olaro, we value your expertise and support your growth at every step. We offer competitive pay, comprehensive benefits, and access to diverse clinical experiences that build your skills and open doors to new possibilities. With 24/7 support, streamlined onboarding, and a team committed to your success, you'll always have a proven guide by your side. Whether you want to explore new locations, broaden your clinical experience, or achieve better work-life balance, Olaro provides the flexibility and support to help you thrive. Join us, and let's shape the future of healthcare together.

This position is for a registered nurse specializing in Labor and Delivery on a 13-week travel assignment in Tracy, California. The role involves 36 hours per week working 12-hour night shifts with comprehensive benefits including housing support, medical coverage from day one, and various reimbursement programs. Host Healthcare provides support throughout the assignment to ensure a comfortable and rewarding travel nursing experience. Host Healthcare is seeking a travel nurse RN Labor and Delivery for a travel nursing job in Tracy, California. Job Description & Requirements Specialty: Labor and Delivery Discipline: RN Start Date: Duration: 13 weeks 36 hours per week Shift: 12 hours, nights Employment Type: Travel Host Healthcare Job ID #a1fVJ000007BKIjYAO. Pay package is based on 12 hour shifts and 36 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN - Labor and Delivery About Host Healthcare At Host Healthcare, we provide a truly comfortable experience as you explore your travel nursing, therapy, or allied career. We make your travel healthcare journey easy by taking care of all the details, so you don't have to. We are on a mission to help others live better and we do this by helping the healers of the world be as comfortable as possible. With access to tens of thousands of travel nursing, therapy, and allied jobs in all 50 states, our responsive and friendly recruiters find your dream position based on what's important to you. During your assignment, get access to premium benefits, including Day 1 medical that continues up to 30 days between assignments, 401K matching, travel reimbursements, dedicated housing support, and more. We also offer 24/7 support from our team and access to our on-staff clinicians so you can feel comfortable and confident throughout your entire assignment. Travel comfortably with Host Healthcare. Benefits Referral bonus School loan reimbursement Vision benefits Wellness and fitness programs Company provided housing options License and certification reimbursement Life insurance Medical benefits Mileage reimbursement Pet insurance Discount program Employee assistance programs Guaranteed Hours Health savings account Holiday Pay 401k retirement plan Continuing Education Dental benefits Keywords: travel nurse, labor and delivery, registered nurse, travel nursing, night shift nurse, healthcare staffing, nursing benefits, temporary healthcare, RN job, clinical nursing

We are so glad you are interested in joining Sutter Health! Organization: SSMC-Sutter Solano Medical Center Accountable for the assessment, coordination, delivery and evaluation of nursing care, including direct patient care, patient/family education and transitions of care in an acute patient setting. Delivers holistic and individualized care to all patients in an assigned area. Develops, implements, and coordinates a plan of care that incorporates psychological, sociocultural, spiritual, economic, and life-style factors. Fosters and maintains collaborative relationships between patients, their family/support group, physicians, and other healthcare providers through timely and effective communications. Adheres to hospital policies, industry standards, best practices, and applicable laws and regulations to promote an optimal patient experience. Job Description: EDUCATION: Other: Graduate of an accredited school of nursing. CERTIFICATION & LICENSURE: RN-Registered Nurse for the state where care is provided BLS-Basic Life Support Healthcare Provider ACLS-Advanced Cardiac Life Support: TYPICAL EXPERIENCE: 2 years of recent relevant experience. SKILLS AND KNOWLEDGE: Demonstrated general knowledge and competence with regard to nursing theories, concepts and practices; medical terminology; anatomy; and physiology. Working knowledge of the healthcare industry, safety precaution policies, best practices regarding patient care and privacy, and changes in local/state/federal regulations. Possess written and verbal communications skills to explain sensitive information clearly and professionally to diverse audiences, including non-medical people. Time management and organizational skills, including the ability to prioritize patient care, assignments and work within standardized policies, procedures, and practices to achieve objectives and meet time sensitive activities. Basic knowledge of computer applications, such as Microsoft Office Suite (Word and Outlook). Work independently as well as be part of the team, while accomplishing multiple interventions in an ever-changing environment. Ability to communicate and engage team members, patients and families in a variety of stressful situations. Use existing procedures and critical thinking to identify and solve routine or complex problems. Ensure the privacy of each patient's protected health information (PHI). Build collaborative relationships with peers and other healthcare providers to achieve departmental and corporate objectives. Prioritize assignments and work within standardized policies, procedures, and scientific methods to achieve objectives and meet deadlines. PHYSICAL ACTIVITIES AND REQUIREMENTS: See required physical demands, mental components, visual activities & working conditions at the following link: Job Requirements For onsite employees: Job Requirements Job Shift: Days Schedule: Part Time Shift Hours: 8 Days of the Week: Variable Weekend Requirements: As Needed Benefits: No Unions: Yes Position Status: Non-Exempt Weekly Hours: 0 Employee Status: Per Diem/Casual Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans. Pay Range is $72.52 to $97.03 / hour The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate's experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.

Travel Labor & Delivery Nurse (Couplet Care, High-Risk) - $2,408 per week at MedPro Healthcare Staffing summary: This position is for a Travel Labor and Delivery Registered Nurse (RN) providing care to women and newborns throughout the childbirth process in a high-risk acute care setting. The role includes monitoring vital signs, supporting patients emotionally and medically, and educating new mothers and their families. The job offers a 13-week travel assignment with competitive pay, benefits including housing allowances, health insurance, and travel reimbursements through a Joint Commission-certified staffing agency. MedPro Healthcare Staffing is seeking a travel nurse RN Labor and Delivery for a travel nursing job in San Ramon, California. Job Description & Requirements Specialty: Labor and Delivery Discipline: RN Start Date: Duration: 13 weeks 36 hours per week Shift: 12 hours, nights Employment Type: Travel MedPro Healthcare Staffing, a Joint Commission-certified staffing agency, is seeking a quality Labor & Delivery Registered Nurse for a travel assignment with one of our top healthcare clients. Requirements Active RN License Degree from accredited nursing program BLS, ACLS, NRP, PALS AWHONN Certifications Eighteen months of recent experience in an Acute Care Labor and Delivery (L&D) setting Other requirements to be determined by our client facility Benefits Weekly pay and direct deposit Full coverage of all credentialing fees Private housing or housing allowance Group Health insurance for you and your family Company-paid life and disability insurance Travel reimbursement 401(k) matching Unlimited Referral Bonuses up to $1,000 Duties Responsibilities Labor and Delivery Nurses (RN), also called perinatal nurses, provide care and support for women before, during and after delivery of the baby. They are responsible for making sure that the medical as well as the emotional needs of the patient are adequately met throughout the entire birthing process. Labor and Delivery (LD) nurses provide care to women and their newborns during the antepartum, intrapartum, postpartum and neonatal stages. Monitor vital signs of the mother and baby during birth. Monitor patients for potential high risk problems. Educate and support mothers and their families after giving birth. About Agency MedPro Healthcare Staffing is a Joint Commission certified provider of contract staffing services. Since 1983, we have placed nursing and allied travelers in top healthcare facilities nationwide. Join us today for your very own MedPro Experience. If qualified and interested, please call for immediate consideration. MedPro Staffing is an Equal Opportunity Employer. All applicants will be considered for employment without attention to race, color, religion, national origin, age, sex, disability, marital status or veteran status. Key Words: Registered Nurse, RN, Labor & Delivery, Contract Nurse, Travel Nurse, Agency RN, Travel RN, Nursing, Contract, L&D, Labor and Delivery, LD *Weekly payment estimates are intended for informational purposes only and include a gross estimate of hourly wages and reimbursements for meal, incidental, and housing expenses. Your recruiter will confirm your eligibility and provide additional details. MedPro Job ID #a0FcxReHEAU. Pay package is based on 12 hour shifts and 36 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Labor & Delivery Registered Nurse Nursing: Labor and Delivery. About MedPro Healthcare Staffing No One Cares More for Caregivers Than MedPro. Focus on your patients, we'll take care of the rest. MedPro Healthcare Staffing is a Joint Commission certified provider of temporary and contract staffing services. Since 1983, we have placed happy nursing and allied travelers in top healthcare facilities nationwide. You deserve a travel experience that's rewarding and memorable. One that allows you to DREAM big. EXPLORE often. And ACHIEVE greatness. The MedPro Experience delivers it! Access to nationwide travel assignments Weekly pay and direct deposit Full coverage of all credentialing fees Private housing or housing allowance Group Health insurance for you and your family Tax Free Per Diems, Housing Stipends and Travel Reimbursements Company-paid life and disability insurance Travel reimbursement Access to our Clinical Nurse Liaison Team 401(k) matching Unlimited Referral Bonuses starting at $500 Benefits Weekly pay Referral bonus Employee assistance programs Keywords: Travel Nurse, Labor and Delivery Nurse, Registered Nurse, RN, High-Risk Pregnancy, Perinatal Nursing, Travel Nursing Jobs, Acute Care Nurse, Contract Nursing, Postpartum Care

**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. _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._ **Work schedule:** Monday - Friday 9:30am - 6pm local time, **with rotating weekends.** **(Saturday 8am-12pm CST, with a comp day during the week)** The **Nurse Reviewer I** will be responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. + Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. + Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. + Partners with more senior colleagues to complete non-routine reviews. + Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization request to assess assessing the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment. **How you will make an impact:** + Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. + Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. + Notifies ordering physician or rendering service provider office of the preauthorization determination decision. + Follows-up to obtain additional clinical information. + Ensures proper documentation, provider communication, and telephone service per department standards and performance metrics. **Minimum Requirements:** + Requires AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. + Current unrestricted RN license in applicable state(s) required. **Preferred Skills, Capabilities, and Experiences :** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PPO and POS plans strongly preferred. + BA/BS degree preferred. + Previous utilization and/or quality management and/or call center experience preferred. + RN Compact License is strongly preferred; CA RN License is also preferred. + Experience in cardiology/radiology is preferred but not required. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $36.27 to $56.77 Locations: 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.

Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: Review prescribing trends and propose cost-saving alternatives. Maintain evidence-based formularies across multiple payers. Conduct retrospective DUR and prepare stakeholder reports. Qualifications: PharmD with managed care, DUR, or pharmacy benefit experience. Strong Excel/data analytics background preferred. Understanding of clinical guidelines and P&T processes. Why Join Us? Join a top-tier managed care team Hybrid flexibility Strategic and data-driven focus

Benefits: Competitive salary Health insurance Opportunity for advancement Care Coordination Department Manager (Acute INPT Case Management) Contract Duration: 13 weeks (Extension Possible) Shift: 5x 8hrs day shift, no weekends Minimum Years of Experience: 5 years Compensation Details: Gross Hourly Pay Rate: $100/hr (Stipend Available) Airfare/Mileage Reimbursement: Upto $500 Specialty: Nursing Sub Specialty(s): Nursing Manager/Director Job Description: Located in Marin County, California, Medical Center is currently seeking an Care Coordination department Manager. Interested Candidates must have the following experience, Minimum of 5 years of previous Care Coordination management/operations experience. STRONG BACKGROUND IN CASE MANAGEMENT AND UTILIZATION REVIEW REQUIRED. This candidate must have previous experience working in a union environment. Expert knowledge of key perioperative standards and compliance specifications (AORN, ASPAN, AAMI, Title-22, OSCHA, etc.) Shift and Schedule: 5x 8hrs day shift, Monday - Friday. 40hrs guaranteed. Compensation: $100.00 per hour About Us Thinksoft Technologies LLC is a leading Global Consulting and IT services company, offering a wide array of solutions customized for a range of key verticals and horizontals. From strategy consulting right through to implementing IT solutions for customers, providing innovative business and technology services that deliver measurable results. As a diverse end-to-end IT solutions provider, Thinksoft offers a range of expertise aimed at helping customers re-engineer and re-invent their businesses to compete successfully in an ever-changing marketplace. We provide a seamless approach to business, technology & professional services by combining excellence in execution with continuous innovation to help our clients effectively compete in the Knowledge Era. Thinksoft Technologies Headquartered in Lutz, Florida and have been working with the clients in a wide range of industries to help them leverage on the strengths of IT to optimize their business performance and produce value-driven results. Our services deliver a total solution package designed to meet our clients complete business and technology needs. With recognized technology and industry expertise, our dedicated professionals focus on understanding clients competitive challenges and implementing the right solutions to achieve their strategic objectives. At Thinksoft Technologies, we strive to build long-term, committed partnerships with our clients, helping them every step of the way on their path to success. THINKSOFT approaches every engagement with one objective in mind - to help our client win and grow. Our Mission Our Mission is to help our clients with professional services of outstanding quality, competence and objectivity, delivering the best solutions to fully satisfy client objectives. Our Vision “Our Vision is to be the leader in providing the highest quality IT solutions and services to the IT sector. we aim to create demand to our services and as well be the first choice of our clients”. Our Values Thinksoft fosters long term and strong relationships with its clients. We show empathy towards our clients and we are committed to their total satisfaction in everything we do.

Are you ready to take your Travel career to the next level? See places you have not seen before? Ventura's MedStaff tenured Recruiters are here to help you find your ideal contract; with over 50 years of combined experience. Markets have changed, but Ventura MedStaff has maintained a leader in the forefront of Therapy, Allied and Nursing opportunities. Our recruiters are here to help answer your questions and provide you with the most up to date information. Contracts run 8-13 weeks, with 36-40-hour guarantees, flexible start dates, and a mix of schedules. Contact one of our dedicated Recruiters to discuss more details. Ventura MedStaff benefits represent the care and compassion we provide for our clients. • Health, dental, vision, life, disability benefits and 401k • Tax free stipends when applicable • Gym discounts • Weekly pay • $750.00 referral bonus Please apply or contract us at: *********************** or ************

Are you ready to take your Travel career to the next level? See places you have not seen before? Ventura's MedStaff tenured Recruiters are here to help you find your ideal contract; with over 50 years of combined experience. Markets have changed, but Ventura MedStaff has maintained a leader in the forefront of Therapy, Allied and Nursing opportunities. Our recruiters are here to help answer your questions and provide you with the most up to date information. Contracts run 8-13 weeks, with 36-40-hour guarantees, flexible start dates, and a mix of schedules. Contact one of our dedicated Recruiters to discuss more details. Ventura MedStaff benefits represent the care and compassion we provide for our clients. •\tHealth, dental, vision, life, disability benefits and 401k •\tTax free stipends when applicable •\tGym discounts •\tWeekly pay •\t$750. 00 referral bonus Please apply or contract us at: www. venturamedstaff. com or ************

Job Description Schedule options (all options are benefits eligible): 8 hour shifts, Monday - Friday, or Tuesday - Friday. 10 or 12 hour shifts Fri/Sat/Sun. Highly desired bilingual (e/s) The Nurse Case Manager (NCM) is a member of the core interdisciplinary team responsible for the care and case management of patient/families admitted to Kid WISE service. The NCM in collaboration with pt/family, physician and interdisciplinary team, develops and coordinates an individualized Plan of Care (POC) that reflects pt/family goals related to safe and comfortable pediatric life limiting Illnesses, enhancing quality of life for child and family, promoting self-determined life closure and effective bereavement. The NCM demonstrates: sensitivity and compassion for the issues involved with serving patients and families facing a terminal illness, death and bereavement; clinical competence in pain and symptom management; and fiscal responsibility in the planning and delivery of services. The Nurse Case Manager provides direct supervision for Hospice Aides and LVNs, when utilized. The Nurse Case Manager will be cross-trained in adult hospice/palliative care, and provide adult hospice nursing care when reasonable and necessary. Essential Responsibilities Patient/family care Recognizes the patient and family as the "unit of care" and active members in the development of the POC Respects patient right to self-determination and acts as advocate within the context of the values and ethical standards of HSCC. Meets pt/family where they are Utilizes nursing process in providing primary care to pt/families Documents all care and care planning per agency policy Provides nursing interventions for pt/family as ordered by the physician and in accordance with the POC, safe nursing practice and the policies and procedures of HSCC Assesses and monitors management of pain and symptoms in collaboration with patient/family, IDG and physician to achieve maximum comfort Exercises good clinical judgment Administers medications and treatments as ordered prn Demonstrates the ability to articulate the parameters of Kid WISE services. Demonstrates the ability to work with pt/families under stress & in crisis Develops, manages, reviews & revises HA POC & supervises HA performance per HSCC policies & procedures Reviews and considers patient data gathered by LVN/HHA when developing and revising the plan of care. Instructs and supports pt/family unit re: symptom management, patient care, disease process & death/dying Participates in providing after-hours coverage to pt/family as needed Participates in coverage of adult hospice care when reasonable and necessary. Case Management Visit frequencies are appropriate to patient status Plans & provides care within the structure of the Conditions of Participation & the Hospice Medicare/Medi-Cal / Concurrent Care Benefit Collaborates with IDT & Attending Physician to develop, manage, review and revise a written POC that includes identified goals, interventions and outcomes that address pt/family physical, psychosocial and spiritual goals related to Safe & Comfortable Dying, Self-Determined Life Closure and Effective Grieving Opens, closes & revises POC per HSCC guidelines Documents all contacts/instructions/ interventions per HSCC policies & procedures Obtains medications, medical supplies and equipment per pt need/physician order Demonstrates understanding of pharmacy-related policies & procedures Assess patient's continued appropriateness for Kid WISE services per HSCC Recertification protocols Completes Recertification documentation in a timely and accurate manner Exercises professional management and coordinates care between and among involved parties in home, community providers and pediatric tertiary specialist. Information Visits and Admissions Conducts information visits and discusses Kid WISE services, explain benefits and eligibility, and answer questions Admit patients on to Kid WISE services, coordinate services, order DME and medications Develops and implements individualized POC based on patient and families goals Review consents with patient/family and obtain signatures Quality Improvement Meets all standards and requirements as indicated by licensing and accrediting agencies Submits verification of current employment related documents per HSCC policies, procedures and licensing agencies Completes and submits all documentation in accordance with policies and procedures Participates in activities that affirm, enhance and develop the highest quality standards for HSCC Participates in developing standards for quality patient care within HSCC Participates in Quality Assessment & Improvement activities as requested Verbal communication is concise, organized and timely per HSCC guidelines Completes and submits all documentation in accordance with policies and procedures Submits completed paperwork & time sheets within the timeframes per HSCC policies & procedures Submits verification of current RN License, TB status, passes OIG/GSA checks, proof of auto insurance/good driving record in a timely manner per HSCC policies, procedures and licensing agencies Special Projects Participates in special projects as requested Performs other related job duties as assigned by Supervisor Compliance Ensures all HIPAA Privacy and Security Regulations, Medicare Conditions of Participation, and all other regulatory/compliance requirements are understood and followed Submits verification of current RN license Submits proof of auto insurance annually; keeps driver's license current and maintains a good driving record Ensures TB checks are completed in a timely manner; at least annually Requirements Certifications, Licenses, Registrations Require current California RN license Valid state driver's license and liability auto insurance Pass OIG/GSA review and all required background checks Education/Experience Degree in Nursing from an accredited college 2 years of pediatric nursing experience or 2 years of hospice or home health nursing experience Previous experience working with electronic medical record charting is desirable End-of-life, pain management, complex care experience preferred Prefer technical experience with Ports, IV's, TPN, Trachs, Oncology, Medsurg, NICU/PICU or Homecare Requires ability to effectively manage self and stress related to pediatric life limiting illnesses /end-of-life /death and dying experiences. Experience in handling emotionally charged situations in calm, respectful manner. And has strong coping skills Skills Desired Previous experience working with end of life is desirable Bilingual in English/Spanish highly desired Physical Demands Sufficient dexterity to utilize electronic record keeping systems, computers/keyboards and or laptops and other related equipment Ability to travel to patient locations; includes ability to drive, negotiate stairs and walkways including uneven surfaces at private homes or facilities Vision ability to read manual and electronic documentation, medications, charts, office related equipment, and instructions Hearing ability within normal range to elicit and detect pertinent information while communicating with patients and health team Speech to verbally communicate to assess and impart information concerning patient status; to complete patient/family teaching and to interact with health care team Work Environment/Environmental Condition Performs services in private homes and will experience a variety of settings and situations Office work is performed in a typical office setting Job Posted by ApplicantPro

Job DescriptionSalary: $55 Hourly / DOE CalAIM Nurse Case Manager Santa Cruz, California About the Organization Stepping Up Santa Cruzis a non-profit organization dedicated to supporting individuals with complex needsincluding mental health,substance use,developmental disabilities, medical vulnerability, and homelessness.We go beyond simply providing services; weempower individualsto reach their full potential by offeringhigh-quality, individualized advocacy.We firmly believe in tailoring our support to each person's unique needs and circumstances.Our passionate team builds rapport toconnect individuals with essential resources which they self-identify,ensuring they have everything they need to thrive. We believe staffs loyalty is earned through giving them the tools to be successful and fulfilled and to reward their hard work through great pay and benefits. About the Position You'll play a vital role as the Enhanced Care Management (ECM) Nurse, part of our integrated service delivery model that takes a whole-person, team-based approach to serving members. The Nurse Case Manager works with the team providing comprehensive care coordination and supportto members enrolled in CalAIMs ECM (Enhanced Care Management) and CS (Community Supports) programs. This dynamic role demands initiative,integrity, dedication,and agenuine desire to make a positive impact on people's lives.Prepare to work in a diverse environment,combining the satisfaction of fostering the growth of your team with community outreach and direct engagement with members. Youll maintain a small caseload while providing critical support and guidance to ECM Case Managers. This includes assisting with member medication reconciliation and offering expertise and advocacy on healthcare-related matters to ensure members receive comprehensive and effective case management. Responsibilities Manage a small caseload to ensure understanding of processes and see areas for improvement. Help members with complex needs get assistance by coordinating and helping to manage their care. Pull outside medical records, including CCAH and SCHIO the local health information exchange (HIE), provide updates to medical care team/PCP, etc. Act as the primary point of contact for other medical specialists who are involved in the members care. Attend specialist and medical appointments with members as needed to support member attendance and understanding of appointments. Utilize screening tools and evidence-based practices to support member-centered care and mutual goal development. Conductin-depth needs assessmentsand developpersonalized care plansin collaboration with members,ensuring Strengths-Based alignment with Trauma-Informed Care (TIC) principles and Harm Reduction philosophy. Provide risk assessment and crisis intervention services as needed. Coordinate care with various providers (doctors,therapists,social workers) through in-person consultations and remote communication,prioritizing culturally competent and member-centered approaches, including developing shared treatment plans, goals and interventions. For members currently hospitalized, in skilled nursing, or receiving other in-patient care, collaborate with provider staff on discharge planning and advocate for in-home services such as visiting nurses, physical and occupational therapy, IHSS, etc. Consult and coordinate with community systems to facilitate linkage, manage referrals and advocate for member needs, with a focus on supporting identified treatment goals. Conduct member meetings at their home or place of choiceto build rapport,assess living environment,and provide direct support to ensure safety and stability. Advocate for member needs,ensuring they receiveappropriate, individualized, and Trauma-Informed care regardless of location or service they are receiving. Monitor member progress andadapt care plans as needed based on member interactions, feedback, and observations,in alignment with best practices for case management and eligibility for billing. Document all member interactions and services accurately and daily,ensuringauthorizations, case notes, case plans, and assessments meet required standards for billing and quality service delivery. Using rapport, respect, and clear expectations and boundaries, de-escalate potentially volatile situationsusing effective communication techniques and understanding the impact of trauma and past experiences. Support the entire ECM/CS team with the varied complex medical needs of our members. Receive, assess, and incorporate feedback to personally and professionally grow. Assist in the development and planning of processes for the four goals of taking care of members, taking care of staff, financial sustainability, and high integrity/professional service delivery. Contribute to apositive and collaborative team environment,both in the office and during outreach activities,fostering inclusivity and respect for diverse experiences. Attend mandatory trainings on-site, online, and off-site at partner agencies for professional development to provide the highest level of service. Drive and manage van and shower trailer when doing outreach with other staff. Other duties as assigned. Minimum Qualifications LVN from an accredited school (RN preferred). Current California Drivers License and proof of auto insurance Eligible to work in the US. Must be 18 years of age or older. Minimum two years of experience working with individuals with complex needs. Minimum two years experience working in the nursing field. Experience in case management. Reliable transportation and ability to transport members occasionally. Must pass a relevant background check as a Medi-Cal provider upon provisional offer of employment and maintain eligibility. Desired Skills Excellent communication, interpersonal and problem-solving skills Strong Computer Literacy in Microsoft Office and Excel and Electronic Health Records (EHR) and willingness to learn other relevant software. Experience working in a CalAIM ECM/CS program desired. Demonstrated understanding and application of Trauma-Informed Care (TIC) principles and Harm Reduction philosophy. Strong soft skills,including assessment,planning,and intervention. Excellent communication and interpersonal skills to connect with members and staff from diverse backgrounds. Ability to work independently and collaboratively in both office and community settings. Strong organizational and time management skills to prioritize competing responsibilities and adapt to dynamic situations. Strong work ethic,self-motivation,and a genuine desire to help others. Must pass a relevant background check as a Medi-Cal provider upon provisional offer of employment and maintain eligibility. Ability to lift up to 35 lbs. occasionally. Bilingual (Spanish and Mixteco preferred) is a plus with hourly bonus of $1.00 per hour. Ability to drive a van and trailer is a plus. Compensation and Benefits Hourly rate of $55.00 per hour with potential for performance-based pay increase after 6 months. 32-hour work week, to support a healthy work-life balance. Generous Paid Time Off (PTO) four (4) weeks per year for relaxation and recharge, and Sick Leave of five (5) days per year. Comprehensive benefits package,including no-cost health coverage with optional dental and vision coverage. Company-sponsored 403(b) retirement savings plan with a generous employer match of 100% of your contributions for up to 5% of your salary. Extensive training,coaching,and tools to empower you to create positive change in members lives and support your professional growth. Opportunities for advancement. Opportunities to improve peoples lives. Pay bonus of $1.00 per hour for bilingual Spanish or Mixteco. Potential for pay bonuses for relevant certifications. We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, creed, ancestry, color, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, weight, height or other physical characteristics, marital status, veteran status, disability status, genetic information, or any other protected characteristics. Additional Information CalAIM is a new program,offering an exciting opportunity to be at the forefront of this impactful work This challenging yet rewarding position allows you to directly impact members' lives through a dynamic mix of office work and community outreach. If you're a passionate,driven individual with a Nursing degree,a willingness to go the extra mile,a heart for helping others, and an acknowledgment of your own self-care, this may be your dream job. Stepping Up Santa Cruz will consider qualified applicants with a criminal history pursuant to the California Fair Chance Act . You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if Stepping Up Santa Cruz is concerned about a conviction that is directly related to the job, you will be given the chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.

Job Description About the Organization Stepping Up Santa Cruz is a non-profit organization dedicated to supporting individuals with complex needs including mental health, substance use, developmental disabilities, medical vulnerability, and homelessness. We go beyond simply providing services; we empower individuals to reach their full potential by offering high-quality, individualized advocacy. We firmly believe in tailoring our support to each person's unique needs and circumstances. Our passionate team builds rapport to connect individuals with essential resources which they self-identify, ensuring they have everything they need to thrive. We believe staff's loyalty is earned through giving them the tools to be successful and fulfilled and to reward their hard work through great pay and benefits. About the Position You'll play a vital role as the Enhanced Care Management (ECM) Nurse, part of our integrated service delivery model that takes a whole-person, team-based approach to serving members. Nurse Case Managers work with a team providing comprehensive care coordination and support to members enrolled in CalAIM's ECM (Enhanced Care Management) and CS (Community Supports) programs. This dynamic role demands initiative, integrity, dedication, and a genuine desire to make a positive impact on people's lives. Prepare to work in a diverse environment, combining the satisfaction of fostering the growth of your team with community outreach and direct engagement with members. You'll maintain a small caseload while providing critical support and guidance to ECM Case Managers. This includes assisting with member medication reconciliation and offering expertise and advocacy on healthcare-related matters to ensure members receive comprehensive and effective case management. Responsibilities: Manage a small caseload to ensure understanding of processes and see areas for improvement. Help members with complex needs get assistance by coordinating and helping to manage their care. Pull outside medical records, including CCAH and SCHIO the local health information exchange (HIE), provide updates to medical care team/PCP, etc. Act as the primary point of contact for other medical specialists who are involved in the member's care. Attend specialist and medical appointments with member as needed to support member attendance and understanding of appointment Utilize screening tools and evidence-based practices to support member-centered care and mutual goal development. Conduct in-depth needs assessments and develop personalized care plans in collaboration with members, ensuring Strengths-Based alignment with Trauma-Informed Care (TIC) principles and Harm Reduction philosophy. Provide risk assessment and crisis intervention services as needed. Coordinate care with various providers (doctors, therapists, social workers) through in-person consultations and remote communication, prioritizing culturally competent and member-centered approaches, including developing shared treatment plans, goals and interventions. For members currently hospitalized, in skilled nursing, or receiving other in-patient care, collaborate with provider staff on discharge planning and advocate for in-home services such as visiting nurses, physical and occupational therapy, IHSS, etc. Consult and coordinate with community systems to facilitate linkage, manage referrals and advocate for member needs, with a focus on supporting identified treatment goals. Conduct member meetings at their home or place of choice to build rapport, assess living environment, and provide direct support to ensure safety and stability. Advocate for member needs, ensuring they receive appropriate, individualized, and Trauma-Informed care regardless of location or service they are receiving. Monitor member progress and adapt care plans as needed based on member interactions, feedback, and observations, in alignment with best practices for case management and eligibility for billing. Document all member interactions and services accurately and daily, ensuring case notes, case plans, and assessments meet required standards for billing and quality service delivery. Using rapport, respect, and clear expectations and boundaries, de-escalate potentially volatile situations using effective communication techniques and understanding the impact of trauma and past experiences. Support the entire ECM/CS team with the varied complex medical needs of our members. Receive, assess, and incorporate feedback to personally and professionally grow. As a potential part of the management team of a new and vibrant nonprofit, assist in the development and planning of processes for the four goals of taking care of members, taking care of staff, financial sustainability, and high integrity/professional service delivery. Contribute to a positive and collaborative team environment, both in the office and during outreach activities, fostering inclusivity and respect for diverse experiences. Attend mandatory trainings on-site, online, and off-site at partner agencies for professional development to provide the highest level of service. Other duties as assigned. Minimum Qualifications LVN from an accredited school (RN preferred). Experience in case management. Valid California Driver's License and ability to operate both personal and company vehicles. Eligible to work in the US. Must be 18 years of age or older. Minimum two years of experience working with individuals with complex needs. Reliable transportation and ability to travel within a 50-mile radius for meetings, trainings and member appointments (mileage reimbursement is provided for use of your own vehicle). Skills & Abilities Excellent communication, interpersonal and problem-solving skills Ability to complete all documentation in accordance with organizational and Medi-Cal requirements. Strong Computer Literacy in Microsoft Office and Excel and Electronic Health Records (EHR) and willingness to learn other relevant software. Experience working in a CalAIM ECM/CS program desired. Demonstrated understanding and application of Trauma-Informed Care (TIC) principles and Harm Reduction philosophy. Strong soft skills, including assessment, planning, and intervention. Excellent communication and interpersonal skills to connect with members and staff from diverse backgrounds. Ability to work independently and collaboratively in both office and community settings. Strong organizational and time management skills to prioritize competing responsibilities and adapt to dynamic situations. Strong work ethic, self-motivation, and a genuine desire to help others. Must pass a relevant background check as a Medi-Cal provider upon provisional offer of employment and maintain eligibility. Ability to lift up to 35 lbs occasionally. Bilingual (Spanish/English and Mixteco preferred) is a plus with hourly bonus of $1.00 per hour. Ability to drive a van and trailer is a plus. Compensation and Benefits Hourly rate of $48.08 per hour with potential for performance-based pay increase after 6 months. Full time 32-hour work week, to support a healthy work-life balance. Generous Paid Time Off (PTO) and Sick Leave of 4 weeks per year for relaxation and recharge. An employee accrues 1 hour of PTO for every 10.4 hours worked, which is a potential 160 PTO hours per year. This works out to 20 days off for a staff member normally working a 32 hour work week. Comprehensive benefits package, including no-cost health coverage with optional dental and vision coverage. Company-sponsored 403(b) retirement savings plan with a generous employer match of 100% of your contributions for up to 5% of your salary. Extensive training, coaching, and tools to empower you to create positive change in members' lives and support your professional growth. Opportunities for advancement. Pay bonus of $1.00 per hour for bilingual English/Spanish or Mixteco. Potential for pay bonuses for relevant certifications. We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, creed, ancestry, color, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, weight, height or other physical characteristics, marital status, veteran status, disability status, genetic information, or any other protected characteristics. Additional Information CalAIM is a new program, offering an exciting opportunity to be at the forefront of this impactful work This challenging yet rewarding position allows you to directly impact members' lives through a dynamic mix of office work and community outreach. If you're a passionate, driven individual with a Nursing degree, a willingness to go the extra mile, a heart for helping others, and an acknowledgment of your own self-care, this may be your dream job. Powered by JazzHR gPXpMoIHE1

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. 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. Work schedule: Monday - Friday 9:30am - 6pm local time, with rotating weekends. (Saturday 8am-12pm CST, with a comp day during the week) The Nurse Reviewer I will be responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. * Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. * Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. * Partners with more senior colleagues to complete non-routine reviews. * Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization request to assess assessing the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment. How you will make an impact: * Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. * Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. * Notifies ordering physician or rendering service provider office of the preauthorization determination decision. * Follows-up to obtain additional clinical information. * Ensures proper documentation, provider communication, and telephone service per department standards and performance metrics. Minimum Requirements: * Requires AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. * Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities, and Experiences: * Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PPO and POS plans strongly preferred. * BA/BS degree preferred. * Previous utilization and/or quality management and/or call center experience preferred. * RN Compact License is strongly preferred; CA RN License is also preferred. * Experience in cardiology/radiology is preferred but not required. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $36.27 to $56.77 Locations: 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. Job Level: Non-Management Non-Exempt Workshift: Job Family: MED > Licensed Nurse 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.

Formulary Strategy & Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: Review prescribing trends and propose cost-saving alternatives. Maintain evidence-based formularies across multiple payers. Conduct retrospective DUR and prepare stakeholder reports. Qualifications: PharmD with managed care, DUR, or pharmacy benefit experience. Strong Excel/data analytics background preferred. Understanding of clinical guidelines and P&T processes. Why Join Us? Join a top-tier managed care team Hybrid flexibility Strategic and data-driven focus

Benefits: Competitive salary Health insurance Opportunity for advancement Care Coordination Department Manager (Acute INPT Case Management) Contract Location: Greenbrae, CA 94904 Duration: 13 weeks (Extension Possible) Shift: 5x 8hrs day shift, no weekends Minimum Years of Experience: 5 years Compensation Details: Gross Hourly Pay Rate: $100/hr (Stipend Available) Airfare/Mileage Reimbursement: Upto $500 Specialty: Nursing Sub Specialty(s): Nursing Manager/Director Job Description: Located in Marin County, California, Medical Center is currently seeking an Care Coordination department Manager. Interested Candidates must have the following experience, Minimum of 5 years of previous Care Coordination management/operations experience. STRONG BACKGROUND IN CASE MANAGEMENT AND UTILIZATION REVIEW REQUIRED. This candidate must have previous experience working in a union environment. Expert knowledge of key perioperative standards and compliance specifications (AORN, ASPAN, AAMI, Title-22, OSCHA, etc.) Shift and Schedule: 5x 8hrs day shift, Monday - Friday. 40hrs guaranteed.

Schedule options (all options are benefits eligible): 8 hour shifts, Monday - Friday, or Tuesday - Friday. 10 or 12 hour shifts Fri/Sat/Sun. Highly desired bilingual (e/s) The Nurse Case Manager (NCM) is a member of the core interdisciplinary team responsible for the care and case management of patient/families admitted to Kid WISE service. The NCM in collaboration with pt/family, physician and interdisciplinary team, develops and coordinates an individualized Plan of Care (POC) that reflects pt/family goals related to safe and comfortable pediatric life limiting Illnesses, enhancing quality of life for child and family, promoting self-determined life closure and effective bereavement. The NCM demonstrates: sensitivity and compassion for the issues involved with serving patients and families facing a terminal illness, death and bereavement; clinical competence in pain and symptom management; and fiscal responsibility in the planning and delivery of services. The Nurse Case Manager provides direct supervision for Hospice Aides and LVNs, when utilized. The Nurse Case Manager will be cross-trained in adult hospice/palliative care, and provide adult hospice nursing care when reasonable and necessary. Essential Responsibilities Patient/family care Recognizes the patient and family as the "unit of care" and active members in the development of the POC Respects patient right to self-determination and acts as advocate within the context of the values and ethical standards of HSCC. Meets pt/family where they are Utilizes nursing process in providing primary care to pt/families Documents all care and care planning per agency policy Provides nursing interventions for pt/family as ordered by the physician and in accordance with the POC, safe nursing practice and the policies and procedures of HSCC Assesses and monitors management of pain and symptoms in collaboration with patient/family, IDG and physician to achieve maximum comfort Exercises good clinical judgment Administers medications and treatments as ordered prn Demonstrates the ability to articulate the parameters of Kid WISE services. Demonstrates the ability to work with pt/families under stress & in crisis Develops, manages, reviews & revises HA POC & supervises HA performance per HSCC policies & procedures Reviews and considers patient data gathered by LVN/HHA when developing and revising the plan of care. Instructs and supports pt/family unit re: symptom management, patient care, disease process & death/dying Participates in providing after-hours coverage to pt/family as needed Participates in coverage of adult hospice care when reasonable and necessary. Case Management Visit frequencies are appropriate to patient status Plans & provides care within the structure of the Conditions of Participation & the Hospice Medicare/Medi-Cal / Concurrent Care Benefit Collaborates with IDT & Attending Physician to develop, manage, review and revise a written POC that includes identified goals, interventions and outcomes that address pt/family physical, psychosocial and spiritual goals related to Safe & Comfortable Dying, Self-Determined Life Closure and Effective Grieving Opens, closes & revises POC per HSCC guidelines Documents all contacts/instructions/ interventions per HSCC policies & procedures Obtains medications, medical supplies and equipment per pt need/physician order Demonstrates understanding of pharmacy-related policies & procedures Assess patient's continued appropriateness for Kid WISE services per HSCC Recertification protocols Completes Recertification documentation in a timely and accurate manner Exercises professional management and coordinates care between and among involved parties in home, community providers and pediatric tertiary specialist. Information Visits and Admissions Conducts information visits and discusses Kid WISE services, explain benefits and eligibility, and answer questions Admit patients on to Kid WISE services, coordinate services, order DME and medications Develops and implements individualized POC based on patient and families goals Review consents with patient/family and obtain signatures Quality Improvement Meets all standards and requirements as indicated by licensing and accrediting agencies Submits verification of current employment related documents per HSCC policies, procedures and licensing agencies Completes and submits all documentation in accordance with policies and procedures Participates in activities that affirm, enhance and develop the highest quality standards for HSCC Participates in developing standards for quality patient care within HSCC Participates in Quality Assessment & Improvement activities as requested Verbal communication is concise, organized and timely per HSCC guidelines Completes and submits all documentation in accordance with policies and procedures Submits completed paperwork & time sheets within the timeframes per HSCC policies & procedures Submits verification of current RN License, TB status, passes OIG/GSA checks, proof of auto insurance/good driving record in a timely manner per HSCC policies, procedures and licensing agencies Special Projects Participates in special projects as requested Performs other related job duties as assigned by Supervisor Compliance Ensures all HIPAA Privacy and Security Regulations, Medicare Conditions of Participation, and all other regulatory/compliance requirements are understood and followed Submits verification of current RN license Submits proof of auto insurance annually; keeps driver's license current and maintains a good driving record Ensures TB checks are completed in a timely manner; at least annually Requirements Certifications, Licenses, Registrations Require current California RN license Valid state driver's license and liability auto insurance Pass OIG/GSA review and all required background checks Education/Experience Degree in Nursing from an accredited college 2 years of pediatric nursing experience or 2 years of hospice or home health nursing experience Previous experience working with electronic medical record charting is desirable End-of-life, pain management, complex care experience preferred Prefer technical experience with Ports, IV's, TPN, Trachs, Oncology, Medsurg, NICU/PICU or Homecare Requires ability to effectively manage self and stress related to pediatric life limiting illnesses /end-of-life /death and dying experiences. Experience in handling emotionally charged situations in calm, respectful manner. And has strong coping skills Skills Desired Previous experience working with end of life is desirable Bilingual in English/Spanish highly desired Physical Demands Sufficient dexterity to utilize electronic record keeping systems, computers/keyboards and or laptops and other related equipment Ability to travel to patient locations; includes ability to drive, negotiate stairs and walkways including uneven surfaces at private homes or facilities Vision ability to read manual and electronic documentation, medications, charts, office related equipment, and instructions Hearing ability within normal range to elicit and detect pertinent information while communicating with patients and health team Speech to verbally communicate to assess and impart information concerning patient status; to complete patient/family teaching and to interact with health care team Work Environment/Environmental Condition Performs services in private homes and will experience a variety of settings and situations Office work is performed in a typical office setting

Santa Cruz, California About the Organization Stepping Up Santa Cruz is a non-profit organization dedicated to supporting individuals with complex needs including mental health, substance use, developmental disabilities, medical vulnerability, and homelessness. We go beyond simply providing services; we empower individuals to reach their full potential by offering high-quality, individualized advocacy. We firmly believe in tailoring our support to each person's unique needs and circumstances. Our passionate team builds rapport to connect individuals with essential resources which they self-identify, ensuring they have everything they need to thrive. We believe staff's loyalty is earned through giving them the tools to be successful and fulfilled and to reward their hard work through great pay and benefits. About the Position You'll play a vital role as the Enhanced Care Management (ECM) Nurse, part of our integrated service delivery model that takes a whole-person, team-based approach to serving members. The Nurse Case Manager works with the team providing comprehensive care coordination and support to members enrolled in CalAIM's ECM (Enhanced Care Management) and CS (Community Supports) programs. This dynamic role demands initiative, integrity, dedication, and a genuine desire to make a positive impact on people's lives. Prepare to work in a diverse environment, combining the satisfaction of fostering the growth of your team with community outreach and direct engagement with members. You'll maintain a small caseload while providing critical support and guidance to ECM Case Managers. This includes assisting with member medication reconciliation and offering expertise and advocacy on healthcare-related matters to ensure members receive comprehensive and effective case management. Responsibilities Manage a small caseload to ensure understanding of processes and see areas for improvement. Help members with complex needs get assistance by coordinating and helping to manage their care. Pull outside medical records, including CCAH and SCHIO the local health information exchange (HIE), provide updates to medical care team/PCP, etc. Act as the primary point of contact for other medical specialists who are involved in the member's care. Attend specialist and medical appointments with members as needed to support member attendance and understanding of appointments. Utilize screening tools and evidence-based practices to support member-centered care and mutual goal development. Conduct in-depth needs assessments and develop personalized care plans in collaboration with members, ensuring Strengths-Based alignment with Trauma-Informed Care (TIC) principles and Harm Reduction philosophy. Provide risk assessment and crisis intervention services as needed. Coordinate care with various providers (doctors, therapists, social workers) through in-person consultations and remote communication, prioritizing culturally competent and member-centered approaches, including developing shared treatment plans, goals and interventions. For members currently hospitalized, in skilled nursing, or receiving other in-patient care, collaborate with provider staff on discharge planning and advocate for in-home services such as visiting nurses, physical and occupational therapy, IHSS, etc. Consult and coordinate with community systems to facilitate linkage, manage referrals and advocate for member needs, with a focus on supporting identified treatment goals. Conduct member meetings at their home or place of choice to build rapport, assess living environment, and provide direct support to ensure safety and stability. Advocate for member needs, ensuring they receive appropriate, individualized, and Trauma-Informed care regardless of location or service they are receiving. Monitor member progress and adapt care plans as needed based on member interactions, feedback, and observations, in alignment with best practices for case management and eligibility for billing. Document all member interactions and services accurately and daily, ensuring authorizations, case notes, case plans, and assessments meet required standards for billing and quality service delivery. Using rapport, respect, and clear expectations and boundaries, de-escalate potentially volatile situations using effective communication techniques and understanding the impact of trauma and past experiences. Support the entire ECM/CS team with the varied complex medical needs of our members. Receive, assess, and incorporate feedback to personally and professionally grow. Assist in the development and planning of processes for the four goals of taking care of members, taking care of staff, financial sustainability, and high integrity/professional service delivery. Contribute to a positive and collaborative team environment, both in the office and during outreach activities, fostering inclusivity and respect for diverse experiences. Attend mandatory trainings on-site, online, and off-site at partner agencies for professional development to provide the highest level of service. Drive and manage van and shower trailer when doing outreach with other staff. Other duties as assigned. Minimum Qualifications LVN from an accredited school (RN preferred). Current California Driver's License and proof of auto insurance Eligible to work in the US. Must be 18 years of age or older. Minimum two years of experience working with individuals with complex needs. Minimum two years experience working in the nursing field. Experience in case management. Reliable transportation and ability to transport members occasionally. Must pass a relevant background check as a Medi-Cal provider upon provisional offer of employment and maintain eligibility. Desired Skills Excellent communication, interpersonal and problem-solving skills Strong Computer Literacy in Microsoft Office and Excel and Electronic Health Records (EHR) and willingness to learn other relevant software. Experience working in a CalAIM ECM/CS program desired. Demonstrated understanding and application of Trauma-Informed Care (TIC) principles and Harm Reduction philosophy. Strong soft skills, including assessment, planning, and intervention. Excellent communication and interpersonal skills to connect with members and staff from diverse backgrounds. Ability to work independently and collaboratively in both office and community settings. Strong organizational and time management skills to prioritize competing responsibilities and adapt to dynamic situations. Strong work ethic, self-motivation, and a genuine desire to help others. Must pass a relevant background check as a Medi-Cal provider upon provisional offer of employment and maintain eligibility. Ability to lift up to 35 lbs. occasionally. Bilingual (Spanish and Mixteco preferred) is a plus with hourly bonus of $1.00 per hour. Ability to drive a van and trailer is a plus. Compensation and Benefits Hourly rate of $55.00 per hour with potential for performance-based pay increase after 6 months. 32-hour work week, to support a healthy work-life balance. Generous Paid Time Off (PTO) four (4) weeks per year for relaxation and recharge, and Sick Leave of five (5) days per year. Comprehensive benefits package, including no-cost health coverage with optional dental and vision coverage. Company-sponsored 403(b) retirement savings plan with a generous employer match of 100% of your contributions for up to 5% of your salary. Extensive training, coaching, and tools to empower you to create positive change in members' lives and support your professional growth. Opportunities for advancement. Opportunities to improve people's lives. Pay bonus of $1.00 per hour for bilingual Spanish or Mixteco. Potential for pay bonuses for relevant certifications. We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, creed, ancestry, color, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, weight, height or other physical characteristics, marital status, veteran status, disability status, genetic information, or any other protected characteristics. Additional Information CalAIM is a new program, offering an exciting opportunity to be at the forefront of this impactful work This challenging yet rewarding position allows you to directly impact members' lives through a dynamic mix of office work and community outreach. If you're a passionate, driven individual with a Nursing degree, a willingness to go the extra mile, a heart for helping others, and an acknowledgment of your own self-care, this may be your dream job. Stepping Up Santa Cruz will consider qualified applicants with a criminal history pursuant to the California Fair Chance Act . You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if Stepping Up Santa Cruz is concerned about a conviction that is directly related to the job, you will be given the chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.

Formulary Strategy & Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: Review prescribing trends and propose cost-saving alternatives. Maintain evidence-based formularies across multiple payers. Conduct retrospective DUR and prepare stakeholder reports. Qualifications: PharmD with managed care, DUR, or pharmacy benefit experience. Strong Excel/data analytics background preferred. Understanding of clinical guidelines and P&T processes. Why Join Us? Join a top-tier managed care team Hybrid flexibility Strategic and data-driven focus

Location: This role enables associates to work virtually full-time, except for 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. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting locations will not be considered for employment, unless an accommodation is granted as required by law. The Nurse Case Manager I is responsible for performing 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 for discharge planning. 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. Minimum Requirements Requires BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. Current, unrestricted RN license in applicable state (CA) required. Preferred Skills, Capabilities and Experiences: Certification as a Case Manager is preferred. Pediatrics experience highly preferred. For candidates working in person or virtually in the below location, the hourly* range for this specific position is $36.28 to $56.77 Location: 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 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. Job Level: Non-Management Non-Exempt Workshift: 1st Shift (United States of America) Job Family: MED > Licensed Nurse 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.