Nurse administrator jobs in Santa Ana, CaliforniaCreate job alerts

Job Description Under general direction of Workers' Compensation Manager, ensures timely processing of workers' compensation claims and evaluates accident reports to determine accuracy and completeness to include handling all day to day functions of the workers' compensation department. ESSENTIAL FUNCTIONS: Evaluates accident reports for completeness of reports to ensure the proper paperwork and information has been reported from the 5 hospitals. If the proper paperwork is not complete, follow up is completed to ensure correct paperwork. Handles day to day duties of workers' compensation program which include multiple tasks and requirements from Workers' Compensation Manager. Duties to include Reporting Injuries and referrals to our hospital for treatment. Evaluates claims and recommends necessary services to include Nurse Case Management, Investigation, Modified Duty, and any other services that may be needed on the file to ensure proper handling. Ensures TPA has all necessary documents to process and adjust claims for KPC Healthcare. If TPA needs any other information or documentation the follow up is completed by the Work Comp Specialist. Communicates with TPA on the handling and adjusting of the workers' compensation claims as needed and responds to requests from TPA regarding information needed for adjusting the claims. Determines what information or additional documentation is needed when requested by the TPA, and obtains the necessary information/documentation. Determines and recommends what type of Investigation Services are needed on a case. Once approved they make the referral to the TPA, within the guidelines of the approved services. If statements are needed, they determine whose statement needs to be taken and facilitates the times and dates with the TPA and Investigation Company. Reviews documentation and or medical reports/status to determine whether temporary total disability benefits should be paid, stopped or continued and communicates findings with TPA. Advises and/or assists departments in conducting investigation of accident reports, including interviewing of witnesses and procurement of relevant documentation. Reviews accident reports to identify patterns of injury and to determine whether unsafe conditions contributed to the accident; advises departments of trends in injuries and proper safety procedures that may result in reduction of injuries; provides department with information that will aid in reducing accidents and improve safety. Documents telephone conversations, witness statements, medical reports and accident investigation results. Attends seminars, conducts research, and maintains liaison with multiple Hospital Departments along with daily communication with the TPA’s handling adjusters. Assists and preforms reporting of workers’ compensation claims utilizing available computer programs, as needed. Reviews, evaluates, interprets and applies existing laws pertaining to workers’ compensation, ensuring compliance with legal requirements, company policies, procedures, and union contracts. Evaluates and assists Workers' Compensation Manager regarding performance of third party claims administrators, legal counsel, medical providers, and other business partners, with an emphasis on team development. Advises employees regarding workers’ compensation matters when needed and or requested. Attends TPA quarterly claims reviews with Workers’ Compensation Manager and all other workers' compensation meetings and or discussions. Evaluates potential modified duty candidates at all 5 hospitals and coordinates with the hospital’s HR Department and employees Department Manager to see if the imposed work restrictions are being accommodated. If accommodated they arrange the signing of the Modified Duty Program document with all parties. Updates the TD and Modified Duty logs to ensure accurate tracking of these programs. Determines and Recommends if an injured employee is a candidate for our offsite Modified Duty Program. If they are determined to be a viable candidate, they will notify the injured employee and advise the TPA to make the referral and will monitor the program on a monthly basis. Reviews and updates return-to-work medical policies/procedures and ensures compliance with KPC Healthcare Inc. LOA Program and works with LOA Specialist when needed on the Interactive Process Requirements: Requires knowledge, skills, and mental development equivalent to the completion of four (4) years of college or any equivalent combination of training and experience. Minimum of 3 years of workers' compensation experience in handling, adjusting, evaluating or maintaining files for an employer, insurance company or TPA. Effective interpersonal, analytical and negotiation abilities required. Ability to provide information in a clear, concise manner with an appropriate level of detail. Demonstrated ability to build and maintain effective relationships. Requires the drive to continue their education by attending seminars and formal workers’ compensation classes in order to achieve the designations of Workers’ Compensation Claims Administrator (WCCA) and Worker’s Compensation Claims Professional (WCCP). Benefits: • Medical, dental and vision coverage is provided for all full time and part time employees*, • Medical is 100% employer paid including dependents*, • Basic Life and AD&D, • 401k plan with company match, • Generous PTO plan*, • Pet Insurance Discount Program*, • Employee Discount Program* *per diem staff ineligible

Job DescriptionDescription: SUMMARY: The ASC Administrator is responsible for providing strategic leadership, compliance and operational oversight for all Ambulatory Surgery Centers (ASCs), focusing on performance improvement, growing existing service lines, and building new service lines. Partners with leaders and doctors to manage all aspects of an ASC operations, processes, and staffing (including Anesthesia). Provides direction and support toward the attainment of company goals and objectives. Ensures that the primary goal of efficiently providing surgical services that exceed customer expectations is achieved, while improving clinical and financial operations. ESSENTIAL FUNCTIONS: To perform this job successfully, an individual must be able to perform each essential function satisfactorily with or without accommodation. The requirements listed below are representative, but not all inclusive, of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions. Responsibilities and Expectations -Responsible for Revenue and Net Operating Income (NOI) performance for ASC. -Manage and optimize operations at all levels in collaboration with local clinical leadership. -Develop statistical indicators to use in evaluating overall operations. Monitor all key metrics and proactively report to leadership any areas of risk or opportunity. -Partners with Compliance to ensure all regulatory, licensing, and credentialing meet and/or exceed requirements. -Oversees the billing process of the ASC, including collections, ensuring authorizations/verifications, patient responsibility received and understood. Business Operations -Develop, monitor and control staffing, operational budget, capital budget, and external contracts. -Closely monitor variations in the financial performance of the facility to avoid cash flow problems. -Ensure compliance to policies and procedures as related to internal controls. -Ensure compliance with government regulatory agencies and accrediting bodies. -Act in accordance with the vision, mission, and business philosophy of the Company. -Other duties as assigned by management. -Closely monitors P&L and looks for ways to improve and meet budget goals. Personnel Administration -Partner with leaders and Doctors on talent acquisition processes as needed. -Lead, coach and mentor staff. -Partner with Human Resources to resolve employee relations issues. -Partner Collaborate with the Medical Director and serve as a liaison in problem areas with the medical staff. Promote positive relationships between employees and practitioners. Clinical Services & Quality Improvement -Ensure delivery of compassionate quality care. Review complaints or concerns from patients or families about nursing services. -Direct the clinical departments of nursing, central supply, medical records, and housekeeping; provide oversight for the contracted services of laboratory, radiology, pharmaceuticals, laundry and biomedical engineering. -Proactively develop procedures to promote workplace safety and safe work practices. -Work in conjunction with the Medical Executive Committee in the evaluation and development of existing and new surgical services. -Collaborate with the Medical Director, Doctors and Nurses in the review and revision of the Medical Staff Bylaws and Rules and Regulations on a biannual basis. -Maintain patient, physician, and employee privacy and confidentiality per policy. -Maintain an appropriate professional appearance and demeanor in accordance with Company policies. -Maintain strict compliance with State, Federal and other regulations (e.g., OSHA, WC, HIPAA, ADA, FEHA, DOL, HR policies and practices). -Stay current with changes in the healthcare environment and act accordingly in the best interest of the Company. -Evaluate and develop continuous quality improvement programs. -Review and ensure correction of quality of care issues. -Works in conjunction with Charge Nurse and DON to improve clinical operations. Requirements: QUALIFICATION GUIDELINES: REQUIRED: -Bachelor's Degree in one of the health professions, business administration, public administration or other related field. -Minimum 5-7 years of related surgical, ambulatory and/or circulating nursing experience. -Minimum 5-7 years of administrative management experience in the health care field. -Strong leadership skills and a high degree of confidence and experience in managing physician relationships, surgical operations, and business/program development. -Ability to influence and effectively interact with patients, staff, peers and leaders. -Ability to frequently move about a facility to direct employees and activities. DESIRABLE: -Experience in the healthcare industry, with multiple surgical facilities preferred. -Experience with regulatory and accreditation processes preferred. CERTIFICATES/LICENSES/REGISTRATIONS: -n/a KNOWLEDGE/SKILLS/ABILITIES/TALENTS: -Knowledge of Surgery Center best practices and operations. -Understanding of budgeting and financial reporting. -Strong leadership skills and ability to coach, teach, and inspire. -Team player and individual contributor coupled with excellent communication skills and interpersonal skills in order to provide guidance to less experienced team members. -Ability to create and deliver consistent training plans. -Computer proficiency including knowledge of Word, Excel and use of standard office equipment. -Ability to understand, develop, and create reports, proposals and presentations. -Effective oral and written communications skills with internal and external customers at all levels. -Ability to respond to common inquiries from customers, staff, vendors, or other members of the business community. -Ability to draw valid conclusions, apply sound judgment in making decisions, and to make decisions under pressure. -Ability to direct the work of others and work as a Team Leader and Coach in attainment of goals. -Ability to interpret and apply policies and procedures. -Ability to address others professionally and respectfully by actions, words and deeds. -Detail oriented, organized, process focused, problem solver, self-motivated, proactive, customer service focused. -Display independent judgment by willingness to make timely and accurate decisions based on available information that is sometimes vague or limited in nature. -Ability to multitask effectively and work in a fast paced and sometimes ambiguous environment, without compromising quality of work. -Ability to prioritize tasks and projects with limited direction, while understanding and contributing to the success of the assigned surgery centers.