Utilization review nurse jobs in Los Angeles, California - Page 2Create job alerts

Job Description Job Title/Position: Clinical Nurse Manager Reports To: Regional Director of Nursing and Administrator Job Description Summary The Clinical Nurse Manager serves as a clinical leader responsible for overseeing hospice clinical operations and ensuring the delivery of high-quality, patient-centered care. This role provides leadership to interdisciplinary teams, ensures regulatory compliance, supports staff development, and promotes continuous quality improvement within a collaborative and compassionate hospice environment. Duties may evolve based on organizational and operational needs. Essential Job Functions/Responsibilities • Oversee clinical staff training to ensure competency in clinical skills and accurate documentation., • Identify staff training needs and coordinate ongoing education and professional development., • Manage and support clinical teams, including nurses and social workers, to ensure the delivery of exceptional patient care., • Supervise clinical office staff, including oversight of prescribing processes, medication management, and clinical resource allocation., • Collaborate with interdisciplinary team members to develop and maintain visit schedules aligned with patient Plans of Care (POC)., • Provide leadership, mentorship, and professional guidance to foster teamwork and staff development., • Conduct face-to-face patient visits as needed to support clinical oversight and patient care requirements., • Write patient prescriptions when necessary and oversee medication compliance and appropriateness., • Participate in the hiring, onboarding, and evaluation of clinical staff., • Perform routine audits to ensure accuracy of admission diagnoses, medication lists, and clinical documentation., • Ensure compliance with Medicare Conditions of Participation (COP) through regular audits and clinical reviews., • Collaborate with physicians and interdisciplinary team members to develop, review, and update patient care plans., • Monitor medication utilization for effectiveness, safety, and cost-efficiency., • Ensure accurate, timely, and compliant documentation, including HIS submissions and Plan of Care updates., • Maintain compliance with Medicare COP, state regulations, and federal hospice requirements., • Promote continuous learning and participate in quality assessment and performance improvement initiatives., • Identify opportunities for clinical improvement and implement strategies to enhance service delivery., • Assist with budgeting, staffing, and resource allocation to optimize operational efficiency., • Perform other duties as assigned. Position Qualifications • Bachelor of Science in Nursing (BSN) required, Master’s degree preferred., • Current RN license in California state., • Minimum of five (5) years of clinical nursing experience., • At least three (3) years of hospice leadership or management experience., • Demonstrated knowledge of Medicare Conditions of Participation and hospice regulatory standards., • Strong leadership, critical thinking, decision-making, and communication skills. Working Conditions & Expectations • Primarily office-based with periodic visits to patient care environments., • Must be available to respond to patient and staff needs outside of regular business hours as required., • Works closely with interdisciplinary team members in a fast-paced and emotionally sensitive hospice care environment. Physical Requirements • Prolonged or considerable walking or standing., • Ability to lift, position, and assist patients as necessary., • Ability to lift supplies and medical equipment., • Frequent reaching, stooping, bending, kneeling, and/or crouching., • Visual and auditory acuity sufficient to perform required nursing and supervisory functions.Company DescriptionAgape Hospice is a dedicated healthcare provider with a compassionate focus on supporting patients and their families.Agape Hospice is a dedicated healthcare provider with a compassionate focus on supporting patients and their families.

Job Description Summary This position is responsible for overseeing the management and safeguarding of medications within a residential treatment program. This position provides support and oversight for resident’s self-administration of medication while in the residential treatment facility. Essential Duties and Responsibilities 1. Conduct admission assessments of residents: health history, vital signs, signs/symptoms of withdrawal from substances, signs/symptoms of mental health disorders, risk assessment, and need for urgent or emergent care., 2. Responsible for receipt and inventory of medication, creating and updating documentation necessary for the storage of an oversight in utilization of medications at the program., 3. Complete consent forms and referrals as necessary to meet the physical health, mental health, and substance abuse treatment needs of residents., 4. Connect residents with health care provider(s) for completion of admission required physical examination and TB clearance, as well as ongoing care as needed to meet the individual needs of residents., 5. Verify resident’s medical insurance information (Medi-Cal and other third-party payors) and coordination efforts with pharmacy., 6. Maintain a clean, orderly, medication room with properly functioning doors, cabinets, and appropriate room and refrigerator temperature, making timely reports to management to resolve any issues., 7. Ensures that a medication inventory is conducted weekly and medication(s) with a ten-day supply or less is/are ordered for refill, or resident is scheduled for follow-up appointment with prescribing provider., 8. Manage the timely ordering/receipt of medications, proper storage, proper destruction of medications, and the documentation required for these activities., 9. Track, document, implement, and communicate medication changes and medication related information to treatment team and supervisor., 10. Maintain accurate records, including the electronic health record and daily medication administration log, reflecting all medication changes, documentation of the use of PRN medication, medication dose changes, and medications discontinuances, including verbal and telephone orders., 11. Review for accuracy of medication prescription orders prior to publishing monthly medication logs for resident’s self-administration of medication., 12. Provide ongoing assessment and observation for treatment response including response to medication (adverse/intended effects)., 13. Coordinate with prescribing practitioners, pharmacies, and treatment team in the provision of mental health services, physical health services, as well as medication and pharmacy related services., 14. Coordinate for any urgent or emergent needs, including referrals and resources., 15. Maintain medication inventory logs on the individual and facility levels., 16. Collect and manage data on MAT services, IMS utilization, overdose prevention/reversals and harm reduction efforts., 17. Maintain all medication and MAT training records of staff., 18. Provide residents with education regarding medication, medication indications, and medication side effects., 19. Provide education on M.A.T. (Medications for Addiction Treatment) for substance use disorders to staff and residents., 20. Communicate effectively with treatment team regarding changes in status and treatment plan, including continuity of care., 21. Document the services provided according to standards set by the Agency and applicable County, State, and Federal regulations. Documentation should be clear, concise, and completed in a timely manner., 22. Facilitate full utilization of service units, including Case Management, as directed by the supervisor., 23. Understand and act in accordance with Social Model Recovery Systems, Inc. Treatment Policies and Procedures Manual, with and emphasis on understanding and carrying out policy related to managing and safeguarding medication., 24. Understand and adhere to all regulatory expectations and ethical standards and Agency policies and procedures, including the Agency’s Core Beliefs., 25. Maintain constructive relationships with family members, community members and organizations, human services agencies, and other professionals., 26. Answer the phone as needed and fill out referral and screening forms, as applicable, fully, and correctly., 27. Attend continued education events related to SUDs, mental health, current treatment trends, and standards of care and share knowledge with treatment team., 28. Attend program staff meetings as required, agency meetings as mandated, and on-site and off-site trainings as directed., 29. Assist in ensuring a safe and alcohol/drug-free environment., 30. Perform all other duties as assigned. Minimum Credential, Education, and Experience 1. Hold a valid license issued by the California Board of Vocational Nursing and Psychiatric Technicians, as a Psychiatric Technician or Licensed Vocational Nurse, 2. Able to complete at least 20 hours of continuing education per year in areas related to behavioral health., 3. Two years’ experience in a behavioral health field. Language and Communication Skills 1. Ability to read and write English fluently., 2. Ability to speak effectively before groups, residents, and family members., 3. Ability to legibly write and document within the Agency’s electronic health record systems., 4. Basic proficiency in using a computer and other telehealth technology. Proficient in Word and Microsoft Office software. Other Requirements 1. Knowledge of 12-Step programs and/or philosophy., 2. Current CPR and First Aid Certifications., 3. A valid government-issued picture ID., 4. If employee uses his/her personal vehicle to commute to work and/or parks on Agency property, a current California driver’s license is required. a. If employee has an out-of-state driver’s license, he/she must attain a valid California license no later than 10 days from employment start date. b. Must maintain current liability insurance coverage on personal vehicle. c. On occasion, employee may be asked to use their personal vehicle to transport s/residents to offsite appointments. Standard mileage rate will be reimbursed as applicable. 5. If employee uses an Agency-owned vehicle to transport residents/s to offsite appointments, a current California driver’s license is required. a. If employee has an out-of-state driver’s license, he/she must attain a valid California license no later than 10 days from employment start date. Company DescriptionSocial Model Recovery Systems (a non-profit 501(c)3 California corporation) provides direct treatment services (at 11 locations in Los Angeles County) for those whose lives have become unmanageable due to alcohol and other drug use and/or whose mental health issues are interfering with leading productive lives. Thousands of individuals have found help in our programs since 1987. We know that ultimately recovery is a personal choice, but we here at Social Model Recovery Systems are here to assist you in your steps to a healthier lifestyle. Social Model Recovery Systems is an Equal Opportunity Employer.Social Model Recovery Systems (a non-profit 501(c)3 California corporation) provides direct treatment services (at 11 locations in Los Angeles County) for those whose lives have become unmanageable due to alcohol and other drug use and/or whose mental health issues are interfering with leading productive lives. Thousands of individuals have found help in our programs since 1987. We know that ultimately recovery is a personal choice, but we here at Social Model Recovery Systems are here to assist you in your steps to a healthier lifestyle.\r\n\r\nSocial Model Recovery Systems is an Equal Opportunity Employer.

Job Description Registered Nurse (RN) – Case Manager Location: Torrance, CA Facility: Providence Little Company of Mary Medical Center Torrance Shift: Days Pay Rate: $57/hour Weekly Gross: ~$2,280 (40 hours) Duration: 13 Weeks Start Date: ASAP Job Overview Join a leading acute care facility as a Registered Nurse (RN) Case Manager and play a critical role in coordinating patient care and discharge planning. In this position, you will work closely with multidisciplinary teams to ensure patients receive appropriate, efficient, and high-quality care throughout their hospital stay and transition to post-acute settings. Responsibilities • Perform comprehensive case management and discharge planning for patients, • Coordinate care across multidisciplinary teams to ensure optimal outcomes, • Conduct utilization reviews and determine medical necessity using evidence-based guidelines, • Manage care plans, including DME needs and disease management, • Assist with admission criteria, prior authorizations, and benefits eligibility, • Ensure compliance with CMS, DRG, and HIPAA regulations, • Maintain accurate documentation in Epic EMR system, • Support patients and families with education and care coordination Requirements • Active California RN License (required; must be active by start date), • Minimum 2 years of acute care case management / discharge planning experience, • BLS Certification required, • Experience with Epic charting system, • Travel experience required (first-time travelers may be considered with screening), • Strong knowledge of utilization review, InterQual criteria, and care coordination Schedule & Additional Details • Shift: Day shift, • Patient Ratio: 1:20, • Weekend Requirement: Every other weekend + holidays, • Floating: Not required, • RTO: Maximum 7 days Facility Details • Type: Acute Care Hospital, • Charting System: Epic, • Dress Code: Business attire or scrubs Preferred Experience (Nice to Have) • Background in Behavioral Health, Home Health, Hospice, or Rehab, • Experience across specialties such as ICU, ER, Pediatrics, or Surgical Services Our team consists of medical and staffing professionals, that understand the value of personal relationships and high speed results. Q2H 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.We have been in the industry for over 30 years, understand the challenges and felt the need to offer a higher service than the rest!\r\n\r\nOur team consists of medical and staffing professionals, that understand the value of personal relationships and high speed results.\r\n\r\nQ2H 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.

Job Description Founded in 2014 in San Francisco Bay Area, Neogen Care’s vision is to transform the way healthcare is provided and received by patients in the home. We strive to improve the quality of your life with our team of specially trained nurses, therapists and reliable caregivers. As a leading provider of medical and non-medical home care services we will continue to contribute to the future of our community and support healthy lifestyles. Neogen Care is a will established Home Health Care agency with patients throughout the California Bay Area, greater Los Angeles, Ventura, San Diego, Orange, San Bernardino and Riverside counties. Our agency is fully partnered with Kaiser Permanente as our primary client. We share Kaiser's culture and vision to provide patient centered care with a strong focus on quality throughout our patient care operations. We have a strong compliance history of successfully passing CHAP surveys and client audits; and operate with ethics at the center of our Core Values. We are looking for a Utilization Review Licensed Vocational Nurse to join our fast-growing team. Become part of a notable company and help us achieve our goals! About the Role: The LVN Utilization Review role is pivotal in ensuring that patient care services are delivered efficiently and in accordance with established clinical guidelines and regulatory requirements. This position involves the thorough evaluation of medical records and treatment plans to determine the appropriateness, necessity, and efficiency of healthcare services provided to patients. The LVN Utilization Reviewer collaborates closely with healthcare providers, insurance companies, and case managers to facilitate optimal patient outcomes while managing healthcare costs. This role requires a keen eye for detail, strong clinical knowledge, and the ability to interpret complex medical information to support decision-making processes. Ultimately, the LVN Utilization Reviewer helps maintain high standards of care and compliance within healthcare organizations across the United States. Minimum Qualifications: • Current and valid Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) license in the United States., • Minimum of 2 years clinical nursing experience, preferably in acute care or related healthcare settings., • Basic understanding of medical terminology, clinical procedures, and healthcare documentation., • Familiarity with utilization review processes and healthcare regulations such as Medicare and Medicaid guidelines., • Experience in utilization review, case management, or healthcare quality assurance., • Certification in Utilization Review or Case Management (e.g., Certified Professional in Utilization Review - CPUR)., • Proficiency with electronic medical records (EMR) systems and healthcare data management software., • Knowledge of insurance payer policies and healthcare reimbursement methodologies., • Minimum Associate degree in Nursing, • Review patient medical records and clinical documentation to assess the necessity and appropriateness of healthcare services., • Evaluate treatment plans and healthcare interventions against established clinical guidelines and payer policies., • Communicate effectively with physicians, nurses, case managers, and insurance representatives to clarify clinical information and resolve discrepancies., • Prepare detailed reports and documentation to support utilization review decisions and ensure compliance with regulatory standards. The LVN Utilization Reviewer applies clinical nursing knowledge daily to analyze patient records and treatment plans critically, ensuring that care provided aligns with best practices and payer requirements. Strong communication skills are essential for collaborating with multidisciplinary teams and negotiating with insurance representatives to facilitate approvals and resolve issues. Attention to detail and analytical skills are used to identify inconsistencies or gaps in documentation that could impact patient care or reimbursement. Familiarity with healthcare regulations and utilization review standards guides the decision-making process to maintain compliance and optimize resource use. Additionally, proficiency with electronic medical records and data management tools supports efficient documentation, reporting, and tracking of utilization review activities.

Job Description Description Under the supervision of the Chief Nursing Officer (CNO)/Deputy Nursing Officer (DNO) and in collaboration with the Site Medical Director, the Nurse Manager I (NM) will provide culturally competent medical services to low-income adult individuals in Los Angeles County, with a specific focus on underserved communities. Provides leadership to RNs, LVNs, medical assistants, HIV/STD counselors, phlebotomist, and other non-administrative staff as hired. The Nurse Manager I will assure quality and cost-effective care for clinic patients, manage a patient’s course of treatment, and coordinate care with providers and other clinical support staff to ensure quality patient outcomes are achieved within established time frames with efficient utilization of resources. In addition, the NM I will work closely with the CNO/DNO to design, implement and monitor workflow processes at the designated Clinic. This position plays a significant part in the implementation of Patient Centered Medical Home (PCMH) Skills rn license, triage, documentation review, patient care, health care, emr, osha, hipaa Top Skills Details rn license,triage,documentation review,patient care,health care,emr,osha,hipaa Additional Skills & Qualifications Clinical Care & Patient Services • Provide clinical support to medical providers before and after adult primary care visits so as to ensure the timely delivery of quality medical care. • Treat patients diagnosed with sexually transmitted infections (STIs) in a timely manner and according to APLA Health clinical STI treatment guidelines. • Administer vaccines to adult patients per APLA Health clinical guidelines. • Provide and appropriately document health education to patients. • Triage adult patients who walk in to clinic or call with acute medical concerns. • Provide chronic disease management (CDM) for patients that are referred by providers and develop appropriate care plan as needed. • Will delegate to LVN appropriate CDM referrals. Care Coordination & Clinic Flow • Interface with other non-administrative staff to ensure patients receive specialty referrals in a timely manner and are able to follow through so as not to interrupt patient care. • Assist front office staff in making appropriate arrangements for patients who arrive late for appointments or for whom an appointment needs to be rescheduled, by reviewing the medical record and determining how soon and where the patient should be seen. • In conjunction with the site medical director and nurse manager conduct morning huddles to align staff on priorities and patient needs. Quality Improvement & Operations • Participate in quality improvement activities as directed by the medical director. • Collaborate with the site medical director and clinic director to optimize operational efficiency and financial performance by continually looking at data that includes patient goals, provider productivity, and pharmacy revenue goals. • Ensures cost effective ordering of supplies. • Will proactively identify opportunities to enhance quality of care, streamline workflows, reduce operational costs, boost staff engagement, and elevate the overall patient experience. Supplies, Equipment & Compliance • Mainta Experience Level Intermediate Level Job Type & Location This is a Contract to Hire position based out of Los Angeles, CA. Pay and Benefits The pay range for this position is $110000.00 - $145000.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision, • Critical Illness, Accident, and Hospital, • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available, • Life Insurance (Voluntary Life & AD&D for the employee and dependents), • Short and long-term disability, • Health Spending Account (HSA), • Transportation benefits, • Employee Assistance Program • Hiring diverse talent, • Maintaining an inclusive environment through persistent self-reflection, • Building a culture of care, engagement, and recognition with clear outcomes Our Bangalore, Hyderabad, Pune, and Chennai delivery centers are hubs of engineering expertise, with core capabilities in mechanical and electrical engineering, systems and software, and manufacturing engineering. Our teams deliver work across multiple industries including transportation, consumer and industrial products, and life sciences. We serve more than 4,500 clients, including many Fortune 500 brands. Learn more about how we can work together at actalentservices.com.

Job Description Adult Primary Care Physician We are seeking Primary Care Physicians who are certified in Internal Medicine, Family Medicine, Emergency Medicine, or Geriatrics. Must be eligible for enrollment to provide services to Medicare and Medi-Cal participants. All-Inclusive Care for the Elderly program provides seniors with the opportunity to continue living in their homes and in their communities. Our innovative and comprehensive range of medical services is what ignites our passion to treat the whole person and not the symptoms! We employ a collaborative interdisciplinary team (IDT) approach to evaluate and guide participant care, which is key to our values, team culture, and mission. PACE program which serves as our patients’ health insurer as well as directly provides comprehensive primary care and social services to keep them living safely in their communities. Reporting to the Chief Medical Officer, the Medical Director will be at the center of an IDT, providing care. PACE is an ideal job for a clinician, as it allows you to spend ample time engaging with and truly caring for patients without the mis-aligned incentives of fee-for-service. Essential Job Duties: • Provide primary care and acute illness evaluation and treatment for a panel of approximately 150 participants, • Perform comprehensive assessments for participants and coordinate with the IDT to develop a comprehensive care plan for each participant, • Be an engaged member of the IDT, communicating participant changes, collaborating on care planning arrangements, and coordinating 24-hour care delivery, • Work collaboratively with network providers and other members of the IDT to ensure effective care coordination, particularly around hospital discharge, short-term, and long-term placement, • Provide direction and guidance to Nurse Practitioners, • Oversee participants’ use of medical specialists and inpatient care, • Participate in rotating night and weekend call, • Oversee all care of participants in the nursing home, providing regular visits as dictated by PACE standards and participants’ needs, • Review outcome and utilization data, including adverse events, hospitalizations, and use of specialists, in collaboration with the IDT to identify opportunities for improved care and operations Requirements Job Requirements: • Successful completion of a residency program accredited by the Accreditation Council for Graduate Medical Education, • Master’s degree/doctorate degree, • Board Certification – Internal Medicine or Family Practice, • Board Certification – Geriatrics preferred, • Active California Physician License without restrictions, • State CDS Certification and DEA Registration, • Valid state driver’s license with a clean DMV record, • Copy of recent vehicle insurance required, • Excellent clinical, organizational, and communication skills in settings with frail, elderly participants, their families, and the IDT Compensation: $250,000-$280,000 with quarterly bonus Benefits:: Benefits Include: apply your clinical expertise in new ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for. • Medical insurance coverage (Medical, Dental, Vision), • Work/life balance - we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and sick time, • 401 K savings + match, • Advancement opportunities - we’ve got a track record of hiring and promoting from within, meaning you can create your own path!, • CME and Paid Time Away, • Equity grants – typically reserved for executives, we want all team members to celebrate our success as a rapidly scaling company, • Malpractice Insurance, • And additional benefits Generous time off - weekends off, 17 days PTO, 6 sick days, & 12 paid holidays Relocation assistance up to $50,000 and $10,000 sign-on bonus CME reimbursement and malpractice/tail coverage Growth opportunities to become a medical director 401K savings + match, as well as equity grants Medical insurance coverage (Medical, Dental, Vision) Regular hours of 8am-5pm, Monday through Friday, including home visits Rotating on-call schedule - a few nights or weekends per month, available by phone only

Job Description Position Summary The RN Case Manager is responsible for performing clinical assessment and reassessment of acute care Inpatients for the purpose of performing utilization review, resource management and safe discharge planning. The RN Case Manager prioritizes, plans, organizes, and implements timeliness of care. Collaborates with the interdisciplinary healthcare team to promote and coordinate the delivery of safe and cost-effective patient care, transition of care and discharge planning. The RN Case Manager advocates for patient self-determination and choice. Practices clinical competence in evaluations and planning with awareness and respect for patient and family diversity. Monitors and coordinates resource utilization throughout the continuum of care and evaluates timeliness of services. Performs admission, continued stay and discharge review utilizing medical staff-approved decision support criteria. Required Qualifications • One year of case management experience or 1 year nursing leadership experience, • Current Licensure as a Registered Nurse in the State of California, • In-depth knowledge and strong understanding of patient throughput, care coordination, and care planning processes, • Ability to assess medical stability for discharge and evaluate medical necessity for continued acute hospitalization, • Computer/EMR Proficiency and Literacy, • Knowledge of CMS, Medicare, Medi-Cal and Managed Care reimbursement, • Familiarity of Joint Commission, CMS, CDPH requirements, • Excellent written and verbal communication skills in English, • Ability to establish and maintain effective working relationships across the organization, • Ability to facilitate and lead interdisciplinary roundsPreferred Qualifications, • Bachelor of Science in Nursing, • Certified Case Manager (CCM), • Acute Hospital Case Management Experience, • Familiarity with AllScripts Care Management, • Proficiency with Milliman Care Guidelines or Interqual, • Collaborates as needed with the patient and family to optimize client outcomes. May include work with community, local and state resources, primary care provider, and members of the health care team, payer, and other relevant health care stakeholders to facilitate appropriate patient transfers, discharges and transitions of care. Identifies timely and effective alternative lower level of care settings for patient care in accordance with the patient's medical necessity, stability, the patients' preferences and health plan benefits. Identifies timely post-hospital needs and arranges for services as appropriate. Provides patient and family appropriate resources and/or referrals. Makes timely and appropriate referrals to, and seeks consultation with others when needed, the patient-centered provision of services; such as Social Services (i.e., Durable Power of Attorney)., • Reviews medical necessity utilizing medical staff-approved evidence-based decision support criteria. to determine appropriate level of care and length of stay. Ensures utilization review is completed and documented concurrently, and provided to the patient's payer as required. Ensures timely escalation of unresolved care coordination issues to the appropriate level. Enters delays in service and avoidable days regarding exceeded payer LOS variances. Communicates denials and physician related utilization management practices to immediate supervisor same day as identified., • Collaborates with patients/caregivers to set goals consistent with physician treatment plans, and patient resources and choices. Collaborates with the multidisciplinary team for timely discharge planning assessments and reassessments and documents concurrently in the patient's medical record in compliance with hospital policy and all regulatory agencies. Provides appropriate instructions to discharge care coordinators as needed., • Acts as an effective liaison to medical staff to ensure continuity and congruity of hospital services in accordance with the patient's plan of care., • Participates in patient and family meetings; respecting and promoting patient choice and documents informed decision making. Utilizes knowledge of psycho-social and physical factors that affect functional status on discharge., • Contributes requested data for the Utilization Management Committee. Click Here for Pay Information -

Job Description Position Summary: The LVN Case Manager is responsible for the coordination of the patient’s care and services. Promotes quality care using a collaborative process that coordinates, monitors, and evaluates services according to the needs of patients. Works together with the patient and family, care team, payers, and external entities to promote a safe transition from the facility to the next provider or care setting care team, payers, and external entities to promote a safe transition from the facility to the next provider or care setting in accordance with all applicable laws, regulations, and Life Care standards. Education, Experience, and Licensure Requirements • Nursing diploma (associate’s or bachelor’s degree in nursing), • Currently licensed/registered in applicable State. Must maintain an active Licensed Practical Nurse (LPN) or Registered Nurse (RN) license in good standing throughout employment., • One (1) year of clinical experience in post-acute care setting preferred, • Prior case management, utilization review, and discharge planning experience preferred, • Generate written communication that is clear, concise, and well organized, • Excellent organizational skills and efficient in prioritizing and managing time and assignments, • Contribute to the organization’s goals and objectives and support the organizational strategic plans, • Expert knowledge in the field of practice, • Make independent decisions when circumstances warrant such action, • Knowledgeable of practices and procedures as well as the laws, regulations, and guidelines governing functions in the post-acute care facility, • Implement and interpret the programs, goals, objectives, policies, and procedures of the department, • Perform proficiently in all competency areas including but not limited to: patient rights, and safety and sanitation, • Maintains professional working relationships with all associates, vendors, etc., • Maintains confidentiality of all proprietary and/or confidential information, • Understand and follow company policies including harassment and compliance procedures Benefits: • 401(k), • Dental Insurance, • Health insurance, • Life insurance, • Paid time off

Job DescriptionDescriptionAstrana Health is looking for a LVN Case Manager who has the ability to commute to our Monterey Park office at 1600 Corporate Center Drive. This position works standard day hours M-F, and we are willing to train a LVN with no case management experience! You will have the ability to work with pediatrics and/or adult populations depending on business need. What You'll Do • Comply with Case Management Department’s policies and procedures, • 95 - 100% compliance with Utilization Management health plan delegation standards for Case Management, • Utilize Milliman Care Guidelines criteria for appropriateness of transition to care by level of skilled needs and acute rehab for post discharge plan, • Collaborating with Hospitalists, case managers, and discharge planners to establish discharge plans at time of admission, • Responsible for coordinating the required initial and concurrent reviews based on the review of medical records received and daily accurate reporting of all inpatient admissions to Medical Director and Manager and/ or Supervisor of Case Management Department, • Review of medical records and/or other documentation to determine medical necessity, appropriateness and level of care utilizing Milliman Care and other appropriate Guidelines, • Assess, plan, implement, coordinate, monitor, and evaluate all options and services with the goal of reducing hospital readmission • Attends/coordinates Case Management meetings on and off-site as necessary, • Interacts with the providers or members as appropriate to communicate determination outcomes in compliance with state, federal and accreditation requirements, • Attend to provider and interdepartmental calls in accordance with exceptional customer service, • Maintain good relationships with health plans, hospitals and medical directors. Resolve problems that arise with any IPA medical directors, • Report to Manager and/or Supervisor of Case Management on activities and/or problems occurring throughout the day, • Available for Hospital on site Case Management, • Other duties as assigned Qualifications • Active Registered Nurse (RN) license in California OR active Licensed Vocational Nurse (LVN) license in California, • Experience using Microsoft applications such as Word, Excel and Outlook, • At least two (2) years of clinical experience as an RN/LVN You're great for this role if:, • Excellent analytical critical reasoning, • Proven ability to prioritize multiple responsibilities simultaneously in a fast-paced, changing environment while meeting deadlines, • Ability to educate and train staff members and other departments as needed, • Experience using EZCAP, • Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located in San Francisco and Daly City., • This role also requires visiting patients in our partnered hospitals. Additional Information: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

Job Description JOB TITLE: Outpatient Prior Authorization Nurse FLSA STATUS: Non-Exempt DEPARTMENT: UM REPORTS TO: Sr. Director UM-RN JOB SUMMARY: Responsible to provide timely review of authorization requests meet national standards and contractual requirements. The prior authorization nurse will promote the quality and cost effectiveness of patient care using clinical acumen. ESSENTIAL JOB FUNCTIONS: • Perform timely review of prior authorization requests for medical necessity by applying appropriate clinical criteria., • Provide accurate and complete documentation with rationale used to approve requests., • Collaborate with various staff within clinical services to coordinate patient care., • Provide appropriate interventions which demonstrate knowledge and sensitivity toward cultural diversity and religious, developmental, health literacy, and educational backgrounds of the population served. Use interpreter services as needed., • Enter and maintain clinical information in authorization systems., • Prepare case summaries and provide clinical criteria for cases that require MD reviews., • Adheres to payroll policies and properly uses timekeeping system with minimal manual changes., • Maintains regular and consistent attendance., • Adheres to Compliance Plan and HIPAA regulations. MARGINAL JOB FUNCTIONS: • Takes on special projects as needed. 1. Continuous Learning: a. Attends staff meetings as required. b. Attends appropriate training, seminars and workshops as required 2. Customer Focus: a. Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations and IMAS’s Standards of Conduct. b. Fosters appropriate communication and relations with Supervisor, co-workers and other staff. 3. Quality/Process Improvement/Safety a. Reports issues of security, health and/or safety to appropriate supervisor as soon as practicable. b. Supports and demonstrates safety throughout all duties performed. c. Follows established policies and procedures and understands and complies with all regulators standards set forth by governing entities. POSITION REQUIREMENTS: EDUCATION/EXPERIENCE: • High school graduate or equivalent., • Minimum 1 year clinical nursing setting experience, • Prior authorization experience preferred SKILLS/KNOWLEDGE/ABILITY: • Knowledge of utilization management principles, • Prior authorization experience preferred, • Familiarity with Medi-Cal and Medicare guidelines, • Willingness and ability to read, write, speak, understand English and have the communications skills necessary to provide accurate information to residents and staff., • Willingness and ability to follow written and verbal direction in English., • Willingness and ability to maintain appropriate level of confidentiality and privacy., • Willingness and ability to interact professionally with all customers, members, and co-workers, individually and as part of a team., • Willingness and ability to effectively handle multiple items/tasks as required and adapt favorably to changing priorities., • Willingness and ability to make appropriate judgments, decisions and problem solving in a timely manner and within the context of the situation at hand., • Ability to effectively prioritize items/tasks as required., • Willingness and ability to take initiative and be a self-starter., • Willingness and ability to understand and comply with Federal, State, and local regulations. LICENSURE/CERTIFICATE/TRAINING: • Active/Current, Unrestricted RN or LVN CA license from an accredited school of nursing.

Job DescriptionSalary: $30 - $40 / Hour DETOX NURSE - BILINGUAL (ENGLISH / SPANISH) CRI-Help is a substance use disorder treatment center with several locations across Los Angeles County. We've been around since 1971 and are noted as an organization practicing integrity in our commitment to ethical and meaningful client care. Our mission is to improve the welfare of the community by providing first-class substance use disorder treatment to adults and families seeking freedom from the bondage of addiction, and we live out that mission everyday with our staff and clients. As a nonprofit organization, CRI-Help is a qualifying employer affording our full-time employees the opportunity to begin, or continue, the process of seeking PSLF (Public Service Loan Forgiveness). In addition, our benefits package for full-time employees is quite robust- especially the option for 100% employer-paid Medical insurance, including an additional 40% paid coverage for dependents, which accompanies our 401k with 4% match option nicely. Please see the full list of benefits below, especially the 12 paid holidays per year (we are a 24/7 facility, so not all employees will be able to take all 12 paid holidays off- but will still get paid for the holiday in addition to their hours worked). CRI-Help is an amazing organization to be a part of and I strongly encourage you to consider joining the team! We opened a new facility in Lincoln Heights in January 2025 and are still hiring for all roles- keep referring back to for current openings at all sites. Basic Function • The Detox Nurse provides feedback and oversight to CRI-Help's Detox, Intake, and Technician Departments regarding clients health statuses during their treatment episodes. Responsibilities • Monitor and assess clients detoxification processes., • Provide nursing care and assist in the pre-admission, admission, treatment, and discharge processes for clients., • Provide medication training and oversight to Detox Technicians and Residential Support Technicians., • Receive MD orders and transcribe them into clients charts., • Observe clients self-administration of medications and treatment as prescribed by written MD orders., • Assess for clients medication reactions and medication adherence., • Assist in medically clearing clients for Detox and Residential levels of care., • Clear clients to volunteer in the kitchen, and to use the gym., • Monitor and review medication tapers for Detox clients., • Conduct utilization reviews with managed care organizations and other third-party payers., • Review Detox and Residential medication logs, reviewing for medication errors, providing corrective supervision when necessary., • Measure vital signs and record results., • Complete necessary client documentation, logs, maintenance reports, and incident reports., • Maintain a minimum of 65% DMC billing productivity per month., • Assist with general Detox Unit duties., • Perform other related duties as assigned by The Director of Nursing. Skills / Knowledge • Must have an advanced understanding of substance use and psychological disorders., • Must understand detoxification protocols, and related care, including symptoms and medications., • Must be able to conduct ASAM, CIWA, and COWS assessments., • Must be able to accurately record information and prepare reports., • Must be able to properly manage medications., • Must have experience working with diverse populations., • Must be able to properly conduct required assessments., • Must be able to navigate CRI-Helps Electronic Health Record (EHR) system., • Must be computer proficient., • Must have advanced knowledge of HIPAA., • Must be familiar with medical/psychiatric problems common to clients with substance use disorders., • Must be able to communicate effectively with clients, treatment team, and outside entities., • Must have an in-depth knowledge of CARF, DHCS Alcohol and / or Other Drug Certification Standards, and Drug Medi-Cal regulations., • Must be Bilingual (English / Spanish) Education / Training • Preferred: Licensed Registered Nurse with the State of California, Department of Consumer Affairs, Board of Registered Nursing, • Minimum Requirement: Must be currently registered with California Board of Vocational Nursing., • Must possess active, classroom CPR and First Aid Certification or BLS Certification. Experience • Must have experience working in a Substance Use Disorder (SUD) facility., • Must have two or more years of clinical nursing experience, preferably in substance abuse treatment. Working Conditions • Occasionally ascend and descend stairs., • Frequently stand and / or sit for 6-8 hours., • Frequently crouch below the waist and / or above the shoulders., • Frequently lift and / or move objects up to 25 lbs., • Occasionally push and / or pull objects up to 25 lbs., • Occasionally work at various locations across Los Angeles County. Special Conditions • Must be willing to undergo random drug screenings. Position Reports To • Director of Nursing Pay Range • $30 - $40 / Hour Position Type • Full-Time, Non-Exempt, Hourly, In-Person Benefits • 100% Paid Blue Shield Trio Plan Medical Insurance Option, • 80% Paid Blue Shield Access+ Plan Medical Insurance Option, • 80% Paid Kaiser Medical Insurance Option, • 40% Dependent Coverage on Medical Insurance Plan, • 80% Paid Dental Insurance, • Vision Insurance, • Paid time off (10 Paid Sick Days Annually, 12 Paid Holidays Annually, Paid Vacation), • Educational Assistance Tuition Reimbursement Program, • 401(k) 4% Employer Match, • 100% Paid $25,000 Life Insurance Plan with option to voluntarily increase coverage CRI-Help ensures that all applicants are treated with equal consideration, without regard to age, race, gender, gender identity, gender expression, transgender status, national origin, ethnic / cultural identification, religion, sexual preference, or disability.

Job Description We’re seeking a detail‐oriented and compassionate Licensed Vocational Nurse (LVN) to join our home health care team as an Office Case Manager. This role blends clinical knowledge with administrative coordination, ensuring that patients receive timely, high‐quality care while supporting field staff and maintaining regulatory compliance. If you enjoy a fast‐paced environment, problem‐solving, and being the hub that keeps operations running smoothly, this position is a great fit. Key Responsibilities: * Coordinate and manage patient care plans in collaboration with RNs, therapists, physicians, and caregivers * Serve as the primary office‐based clinical support for field staff * Review clinical documentation for accuracy, completeness, and compliance * Schedule patient visits and ensure timely follow‐up on orders, labs, and care needs * Communicate with patients, families, and providers to support continuity of care * Track and manage authorizations, insurance requirements, and visit utilization * Assist with intake, including verifying eligibility and gathering clinical information * Maintain accurate records in the EMR and support quality assurance activities * Participate in case conferences and interdisciplinary team meetings * Support survey readiness and adherence to state, federal, and agency regulations * Active California LVN license in good standing Required Qualifications * Minimum 5 years of Office Case Management experience, preferably in home health, or a related setting * Strong understanding of home health regulations, documentation standards, and care coordination * Proficiency with EMR systems Data Soft Logic * Excellent communication, organization, and multitasking skills * Ability to work independently in an office environment while supporting a remote clinical team * Strong knowledge of Medicare, Medi‐Cal, and private insurance guidelines * Strong critical‐thinking skills and comfort with fast‐paced administrative workflows Patient and Family Communication: • Serve as a point of contact for patients and their families, providing updates on appointments, services, and care plans., • Ensure that patients and family members understand their treatment plans, scheduled appointments, and the services provided by home health agencies., • Assist with maintaining accurate patient records in compliance with healthcare regulations and company policies., • Help case managers with the preparation of patient documentation, including care plans, assessment forms, and progress notes., • Help patients and families access community resources, including home health aides, transportation, or financial assistance programs., • Assist with arranging referrals to specialists or other healthcare professionals as needed., • Help monitor patient care and assist with ensuring that healthcare standards and regulations are met., • Prepare reports and assist in tracking the progress of individual patients and overall case load management., • Support case managers with general administrative duties such as filing, copying, and organizing patient care documents., • Education: High school diploma. Some college coursework or a degree in healthcare administration, nursing, or a related field is preferred., • Experience: Prior experience in home health, case management, or healthcare administration is preferred but not required., • Skills: Work Environment: • The Case Manager will work in an office setting, • Must have pleassant personality and must posses willingness to help new tasks., • Maintain a compassionate, patient-centered approach to patient care., • Demonstrate the ability to adapt to changing priorities and workloads in a fast-paced healthcare environment.

Job DescriptionDescription: Haven Health, a well-established home health agency hiring RN's! Haven is a thriving home health agency seeking nurses that want to make a difference and be part of a team of health care professionals that are committed to quality nursing care. We provide all levels of care to patients in our community, who need our help to recover from a myriad of ailments. We specialize in complex and high-tech nursing for wound care, intravenous therapies and rehabilitation. We are located in Long Beach (Signal Hill) and service both LA and Orange Counties. All new clinical employees go through an extensive orientation process, that is based on the principals of observing, being observed and independent performance. All new employees are given the option of determining when they are ready for independent performance. We will provide all training needed and facilitate proficiency in tasks for clinical staff. So, if you're ready to help us lay the groundwork for our ever-growing well-established company, then we invite you to join our team! You will have the opportunity to learn and work alongside industry experts who have been in the healthcare field for over 20 years. RESPONSIBILITIES: • Admits patients to agency, • Provides follow up visits for patients when admissions are not available, • Coordinates admission with case manager and intake staff, • Notifies the doctor of any changes in condition and requests new orders as needed, • Advises the Director of Nursing on current events, problems, and Agency's operations on a daily basis, or as needed., • Keeps informed of new developments as related to the Agency in regard to State and Federal regulatory agencies., • Assures quality of patient care by working closely with the Utilization Review/Quality Assurance Coordinator and follows through on corrective action when appropriate., • Acts as a liaison among Agency personnel, client/client’s family members and physicians when necessary, • Attends meetings and trainings as requested or required, • Participate in on-call rotation, • Adheres to Agency's policies and procedures, • Active license the State Board of Nurses as a registered nurse., • 1 year or more as an RN preferred, • LVN experience a plus, • Ability to work independently with minimal supervision., • TB Test and Physical exam six months prior to employment or within 14 days of the date of employment and a TB thereafter annually. A chest x-ray, because of a positive TB PPD test and physicians recommendation for x-ray., • Valid Driver’s license and auto insurance, • Satisfactory references., • Spanish Speaker preferred, • Medical, Dental, and Vision Insurance, • Mileage Reimbursement, • Paid Company Holidays, • Paid Time Off, • 401(k) Language: • Spanish (Preferred)

Job DescriptionDescription: Haven Health, a well-established home health agency hiring RN's! Haven is a thriving home health agency seeking nurses that want to make a difference and be part of a team of health care professionals that are committed to quality nursing care. We provide all levels of care to patients in our community, who need our help to recover from a myriad of ailments. We specialize in complex and high-tech nursing for wound care, intravenous therapies and rehabilitation. We are located in Long Beach (Signal Hill) and service both LA and Orange Counties. All new clinical employees go through an extensive orientation process, that is based on the principals of observing, being observed and independent performance. All new employees are given the option of determining when they are ready for independent performance. We will provide all training needed and facilitate proficiency in tasks for clinical staff. So, if you're ready to help us lay the groundwork for our ever-growing well-established company, then we invite you to join our team! You will have the opportunity to learn and work alongside industry experts who have been in the healthcare field for over 20 years. RESPONSIBILITIES: • Admits patients to agency, • Provides follow up visits for patients when admissions are not available, • Coordinates admission with case manager and intake staff, • Notifies the doctor of any changes in condition and requests new orders as needed, • Advises the Director of Nursing on current events, problems, and Agency's operations on a daily basis, or as needed., • Keeps informed of new developments as related to the Agency in regard to State and Federal regulatory agencies., • Assures quality of patient care by working closely with the Utilization Review/Quality Assurance Coordinator and follows through on corrective action when appropriate., • Acts as a liaison among Agency personnel, client/client’s family members and physicians when necessary, • Attends meetings and trainings as requested or required, • Participate in on-call rotation, • Adheres to Agency's policies and procedures, • Active license the State Board of Nurses as a registered nurse., • 1 year or more as an RN preferred, • LVN experience a plus, • Ability to work independently with minimal supervision., • TB Test and Physical exam six months prior to employment or within 14 days of the date of employment and a TB thereafter annually. A chest x-ray, because of a positive TB PPD test and physicians recommendation for x-ray., • Valid Driver’s license and auto insurance, • Satisfactory references., • Spanish Speaker preferred, • Medical, Dental, and Vision Insurance, • Mileage Reimbursement, • Paid Company Holidays, • Paid Time Off, • 401(k) Language: • Spanish (Preferred)

Job DescriptionBenefits: • 401(k), • 401(k) matching, • Dental insurance, • Health insurance, • Vision insurance Provides overall coordination in the delivery of medical services and discharge planning for a specified patient population. Performs concurrent review of patient medical records for purposes of utilization review, compliance with requirements of external review agencies including governmental and non-governmental payers and quality assurance agencies. Promotes a cooperative and supportive relationship as liaison with patient, family, facility staff, physicians, funding representatives and community agencies. Ensures continuity in the handoff of patient clinical information from the hospital to other involved healthcare entities. Duties and Responsibilities • Screens calls for admissions against Milliman Care Guidelines (MCG) to determine if member required Observation admissions vs Inpatient admission to the acute care setting. Process inpatient denial and approving observation efficiently., • Facilitates patients transfer to contracted hospital when admitted to an out of network and needs continued hospitalization within 24 hours of admission. The nurse follows the Out of Network Transfer Protocol and documents the specific reason/s why patient is not repatriated back into network or capped facility. (Non-repatriation codes), • Facilitates Emergency Room (ER) transfers when patients require admission. The nurse assesses and verifies if the patient is stable for transfer if stable will proceed to Step 1a. If unstable or no bed is available, the nurse gives authorization to admit the patient. Coordinates transfers of patients for higher level of care (tertiary, quaternary), • Verifies if the attending physician assigned on the case is the contracted hospitalist. If assigned attending is not the correct hospitalist, the nurse switches the providers by calling the contracted hospitalist on the case, once accepted, the nurse informs the attending provider that IPA contracted hospitalist will be taking over the case., • Calls the hospital UR Department, SNF CM or hospitalist to request initial reviews, concurrent reviews, and discharge needs. Documents daily clinical reviews in the EZ-cap system and assigns the appropriate Level of Care (LOC) and approves the authorization if deemed medically necessary using MCG or Health Plan required guidelines., • Identifies potential CCS cases (contracted CCS hospital/provider), obtaining the SAR, referring cases to CCS, • Identifies unnecessary or aberrant days and forwards the information to the Medical Director for final review and determination of potential denial of days. Forwards the case to the Notice of Action (NOA) Coordinator for denial or modification letter generation. The nurse ensures that the case is closed accurately, and documents ADMIT TYPE, ADMIT SOURCE, PATIENT STATUS on the Auth Details Field within the required ICE TAT., • Coordinates discharge needs and provides authorization i.e., home health care PT, OT, skilled nursing visits, home infusion, Self-injectable drugs, DME, medical supplies, etc., • Forwards to Realignment team/ Member Liaisons information of SNF patient who is admitted to long-term care and has resided in a nursing facility beyond 30 days after the month of admission to facilitate disenrollment of member from managed Care Medical back to Fee for Service Medi-cal., • Attends the daily inpatient meeting to go over daily bed day reports with the Medical Directors., • Refers potential readmissions to Outpatient High Risk Case Management (SPD, SNP, CMC) or Readmission Teammates (non-SPD, non-SNP, non-CMC) for follow-up post discharge. Refers any potential quality of care issues (PQI) identified to the QI Department for review of QI cases., • Current RN or LVN licensure; Preferred: BSN level of education., • Working knowledge of case management philosophy/process/role, needs assessment, principles of utilization review/quality assurance, use of Milliman or other clinical decision support criteria, discharge planning, and reimbursement structures (i.e. Government and non-governmental payers)., • Ability to read, analyze and comprehend complex clinical data and its application to level of care criteria and discharge options; strong, broad-based clinical knowledge and understanding of pathology/physiology of disease processes; excellent critical thinking skills; assertive personality traits to facilitate ongoing physician communication; organize, prioritize and manage time efficiently. This is a remote position.

Job Description Position Summary The Utilization Review/Management Nurse is accountable for planning, directing, and overseeing aspects of daily Utilization Review operations across ALTA/Southern CA facilities where needed. The Utilization Review/Management Nurse is also responsible in performing and completing medical necessity reviews utilizing McG and Interqual Review Guidelines ensuring adherence to said guidelines for admission and continued stay reviews. The Utilization Review/Management Nurse is also responsible in coordinating the Physician Advisor review/referral process per policy. The Utilization Review/Management Nurse is also responsible in coordinating discharge planning efforts of medically complex patients with barriers to safe transition to the next appropriate level of care. The Utilization Review/Management Nurse is also responsible in performing focused readmission reviews as assigned, identifying trends and recommends action plans based on opportunities and trends identified during the review process. Essential Job Functions The essential functions below are not intended to be an exhaustive list of all duties that may be assigned to this position, nor does it restrict the duties which may be assigned to this position if such duties reasonably relate to the position. • Applies medical necessity per hospital-approved utilization review criteria to determine appropriate level of care and length of stay, • Ensures utilization review is completed and documented concurrently and provided to the patient's payer as required. Ensures timely escalation of unresolved care coordination issues to the appropriate level. Proactively communicates with physicians to discuss opportunities identified related to lack of medical necessity of admission and continued stay. Recommends level of care, i.e., inpatient or observation based on clinical indicators, • Communicates denials and physician-related utilization management practices to immediate supervisor timely. Facilitates/coordinates P2P reviews as needed. Coordinates Physician Advisor referral process. Ensures timely referrals of cases to Physician Advisor and timely Physician Advisor intervention. Performs focused readmission reviews as assigned, identifies trends and recommends action plans based on opportunities and trends identified during the review process., • Current Licensure as a Registered Nurse in the State of California, • Four (4) years of experience in an Acute Care Case Management role or Utilization Management., • Knowledge of McG and Interqual Criteria application, • Excellent verbal and written communication skills, • Computer literacy and proficiency, • Knowledge of all Federal, State and Local regulatory standards, • Professional demeanor with healthcare team, • Strong Organizational and Time Management skills with ability to effectively prioritize tasks., • Bachelor of Science in Nursing (BSN) These are requirements normally expected to perform regular job duties. Reasonable accommodations may be made in compliance with the Americans with Disabilities Act of 1990, and applicable state and local law, to enable individuals with disabilities to perform the essential functions. Incumbent must be able to successfully perform all of the essential functions of the job with or without reasonable accommodation. • Standing - Frequently, • Walking - Frequently, • Sitting - Frequently, • Reaching with Hands and Arms - Occasionally, • Climb or Balance - Occasionally, • Stooping, Kneeling, Crouching, or Crawling - Occasionally, • Talking - Constantly, • Hearing - Constantly, • Seeing - Constantly, • Performing repetitive motions with arms or hands - Occasionally, • Lifting, carrying, pushing or pulling up to 10 lbs - Constantly, • Lifting, carrying, pushing or pulling up to 25 lbs - Occasionally, • Lifting, carrying, pushing or pulling up to 50 lbs - Occasionally, • Lifting, carrying, pushing, or pulling greater than 50 lbs - None

Job DescriptionDescription: Haven Health, a well-established home health agency hiring RN's! Haven is a thriving home health agency seeking nurses that want to make a difference and be part of a team of health care professionals that are committed to quality nursing care. We provide all levels of care to patients in our community, who need our help to recover from a myriad of ailments. We specialize in complex and high-tech nursing for wound care, intravenous therapies and rehabilitation. We are located in Long Beach (Signal Hill) and service both LA and Orange Counties. All new clinical employees go through an extensive orientation process, that is based on the principals of observing, being observed and independent performance. All new employees are given the option of determining when they are ready for independent performance. We will provide all training needed and facilitate proficiency in tasks for clinical staff. So, if you're ready to help us lay the groundwork for our ever-growing well-established company, then we invite you to join our team! You will have the opportunity to learn and work alongside industry experts who have been in the healthcare field for over 20 years. RESPONSIBILITIES: • Admits patients to agency, • Provides follow up visits for patients when admissions are not available, • Coordinates admission with case manager and intake staff, • Notifies the doctor of any changes in condition and requests new orders as needed, • Advises the Director of Nursing on current events, problems, and Agency's operations on a daily basis, or as needed., • Keeps informed of new developments as related to the Agency in regard to State and Federal regulatory agencies., • Assures quality of patient care by working closely with the Utilization Review/Quality Assurance Coordinator and follows through on corrective action when appropriate., • Acts as a liaison among Agency personnel, client/client’s family members and physicians when necessary, • Attends meetings and trainings as requested or required, • Participate in on-call rotation, • Adheres to Agency's policies and procedures, • Active license the State Board of Nurses as a registered nurse., • 1 year or more as an RN preferred, • LVN experience a plus, • Ability to work independently with minimal supervision., • TB Test and Physical exam six months prior to employment or within 14 days of the date of employment and a TB thereafter annually. A chest x-ray, because of a positive TB PPD test and physicians recommendation for x-ray., • Valid Driver’s license and auto insurance, • Satisfactory references., • Spanish Speaker preferred, • Medical, Dental, and Vision Insurance, • Mileage Reimbursement, • Paid Company Holidays, • Paid Time Off

Job DescriptionDescription: Haven Health, a well-established home health agency hiring RN's! Haven is a thriving home health agency seeking registered nurses that want to make a difference and be part of a team of health care professionals that are committed to quality nursing care. We provide all levels of care to patients in our community, who need our help to recover from a myriad of ailments. We specialize in complex and high-tech nursing for wound care, intravenous therapies and rehabilitation. We are located in Long Beach (Signal Hill) and service both LA and Orange Counties. All new clinical employees go through an extensive orientation process, that is based on the principals of observing, being observed and independent performance. All new employees are given the option of determining when they are ready for independent performance. We will provide all training needed and facilitate proficiency in tasks for clinical staff. So, if you're ready to help us lay the groundwork for our ever-growing well-established company, then we invite you to join our team! You will have the opportunity to learn and work alongside industry experts who have been in the healthcare field for over 20 years. RESPONSIBILITIES: • Admits patients to agency, • Provides follow up visits for patients when admissions are not available, • Coordinates admission with case manager and intake staff, • Notifies the doctor of any changes in condition and requests new orders as needed, • Advises the Director of Nursing on current events, problems, and Agency's operations on a daily basis, or as needed., • Keeps informed of new developments as related to the Agency in regard to State and Federal regulatory agencies., • Assures quality of patient care by working closely with the Utilization Review/Quality Assurance Coordinator and follows through on corrective action when appropriate., • Acts as a liaison among Agency personnel, client/client’s family members and physicians when necessary, • Attends meetings and trainings as requested or required, • Participate in on-call rotation, • Adheres to Agency's policies and procedures, • Active license the State Board of Nurses as a registered nurse., • 1 year or more as an RN preferred, • LVN experience a plus, • Ability to work independently with minimal supervision., • TB Test and Physical exam six months prior to employment or within 14 days of the date of employment and a TB thereafter annually. A chest x-ray, because of a positive TB PPD test and physicians recommendation for x-ray., • Valid Driver’s license and auto insurance, • Satisfactory references., • Spanish Speaker preferred, • Medical, Dental, and Vision Insurance, • Mileage Reimbursement, • Paid Company Holidays, • Paid Time Off

Job Description Practice Areas: Internal Medicine & Family Medicine Note: Compensation is determined based on the years of experience and qualifications. Position Purpose: This position is responsible for managing the medical care of an assigned patient caseload, working collaboratively with the Chief Medical Director as outlined in the established protocol. The role includes operational leadership of the primary care team and reports to the physician team leader overseeing primary care operations. The Physician Specialist will also work closely with a nurse to support patient case management. Principal Responsibilities: • Provide medical care to underserved primary care patients., • Coordinate and deliver primary and preventive medical care to an assigned patient panel., • Provide consultation to the nurses and other clinical staff regarding the medical care of patients., • Consult with the Medical Director regarding the performance of midlevel providers and other back-office staff., • Collaborate on planning and directing the activities of the primary care team as related to the physician’s specialty., • Participate in medical service utilization audits, peer review, and quality assurance initiatives., • Contribute to population health management efforts, focusing on HEDIS quality measures for paneled patients., • Sign Delegation of Services Agreements for midlevel providers, following standardized procedures and protocols., • Current California Physician & Surgeon License., • Current DEA Certificate., • Current CPR Certification., • Ability to travel from site to site as needed., • Experience in working with clients and staff from diverse socio-economic, ethnic, and cultural background., • Demonstrated ability to implement patient-centered care approaches and evidence-based practices. Note: If you become a JWCH provider, you may be able to participate in Loan Repayment Program. A majority of our clinics are NHSC approved sites. The National Health Service Corp may be accepting applications Loan Repayment Program awards. The program is open to licensed primary care medical, dental, and mental and behavior health providers who are employed or have accepted an offer of employment at an NHSC-approved site. Awardees receive up to $50,000 in exchange for two years of service if they practice in a HPSA of 14 above (Tier I). Awardees can also receive up to $30,0000 in exchange for two years of service if they practice in a HPSA of 13 and below (Tier II). You will need to contact National Health Service Corp to apply and receive more information. Upon acceptance, you are encouraged to apply to National Health Service Corp for Loan Repayment Program. Employee Benefits: At JWCH Institute, Inc., we believe in taking care of those who take care of others. If you work 30+ hours per week, you’ll enjoy competitive pay and a robust benefits package that includes: • Medical, Dental, Vision, • Monthly employer-sponsored allowance for assistance with health premiums., • Funded Health Savings Account (up to deductible) to assist with carrier-approved medical expenses., • Paid time off (vacation, sick leave) and 13 paid holidays., • 401(k) Safe Harbor Profit Sharing plan., • Mileage reimbursement., • Short- and long-term disability plans (LTD/STD). JWCH Institute, Inc + Wesley Health Centers is an Equal Opportunity and Fair Chance Employer.

Job Description Description: The RN Case Manager is responsible for performing clinical assessment and reassessment of acute care Inpatients for the purpose of performing utilization review, resource management and safe discharge planning. The RN Case Manager prioritizes, plans, organizes, and implements timeliness of care. Collaborates with the interdisciplinary healthcare team to promote and coordinate the delivery of safe and cost-effective patient care, transition of care and discharge planning. The RN Case Manager advocates for patient self-determination and choice. Practices clinical competence in evaluations and planning with awareness and respect for patient and family diversity. Monitors and coordinates resource utilization throughout the continuum of care and evaluates timeliness of services. Performs admission, continued stay and discharge review utilizing medical staff-approved decision support criteria. Responsibilities: • Collaborates as needed with the patient and family to optimize client outcomes. May include work with community, local and state resources, primary care provider, and members of the health care team, payer, and other relevant health care stakeholders to facilitate appropriate patient transfers, discharges and transitions of care. Identifies timely and effective alternative lower level of care settings for patient care in accordance with the patient's medical necessity, stability, the patients' preferences and health plan benefits. Identifies timely post-hospital needs and arranges for services as appropriate. Provides patient and family appropriate resources and/or referrals. Makes timely and appropriate referrals to, and seeks consultation with others when needed, the patient-centered provision of services; such as Social Services (i.e., Durable Power of Attorney)., • Reviews medical necessity utilizing medical staff-approved evidence-based decision support criteria. to determine appropriate level of care and length of stay. Ensures utilization review is completed and documented concurrently, and provided to the patient's payer as required. Ensures timely escalation of unresolved care coordination issues to the appropriate level. Enters delays in service and avoidable days regarding exceeded payer LOS variances. Communicates denials and physician related utilization management practices to immediate supervisor same day as identified., • Collaborates with patients/caregivers to set goals consistent with physician treatment plans, and patient resources and choices. Collaborates with the multidisciplinary team for timely discharge planning assessments and reassessments and documents concurrently in the patient's medical record in compliance with hospital policy and all regulatory agencies. Provides appropriate instructions to discharge care coordinators as needed., • Acts as an effective liaison to medical staff to ensure continuity and congruity of hospital services in accordance with the patient's plan of care., • Participates in patient and family meetings; respecting and promoting patient choice and documents informed decision making. Utilizes knowledge of psycho-social and physical factors that affect functional status on discharge., • One year of case management experience or 1 year nursing leadership experience, • Current Licensure as a Registered Nurse in the State of California, • In-depth knowledge and strong understanding of patient throughput, care coordination, and care planning processes, • Ability to assess medical stability for discharge and evaluate medical necessity for continued acute hospitalization, • Computer/EMR Proficiency and Literacy, • Knowledge of CMS, Medicare, Medi-Cal and Managed Care reimbursement, • Familiarity of Joint Commission, CMS, CDPH requirements, • Excellent written and verbal communication skills in English, • Ability to establish and maintain effective working relationships across the organization, • Bachelor of Science in Nursing, • Certified Case Manager (CCM), • Acute Hospital Case Management Experience, • Familiarity with AllScripts Care Management, • Proficiency with Milliman Care Guidelines or Interqual

Job Description Join Our Team as an Experienced Workers Compensation Case Manager Advance Your Career with Rising Medical Solutions Are you an experienced workers’ compensation nurse case manager eager to bring your expertise to a team that’s passionate about making a genuine impact on the lives of injured workers? At Rising Medical Solutions, you’ll join a group of dedicated professionals committed to elevating the standards of medical case management for workplace injuries and find a collaborative environment where your prior experience is valued, and your skills are essential to our mission. At Rising Medical Solutions, your prior expertise will be vital as you: • Collaborate with injured employees, employers, healthcare providers, workers’ compensation adjusters, and fellow team members to continuously evaluate and enhance treatment plans., • Draw upon your comprehensive experience to identify and overcome barriers in the recovery process, advocating for the best possible outcomes for all stakeholders. Together, we can make every step of the recovery journey count. Requirements • Candidates will have a strong background in at least one of the following specialties: industrial rehabilitation nursing, medical case management, occupational health, orthopedics, home health care, utilization review, or quality assurance, • Familiarity with regional physicians, • CCM, and COHN-S/CM are optional but highly valued, • Ability to drive to appointments within a 2-hour radius, • Opportunity to make a difference in reducing health care costs and increasing the value of health care to individuals and their employers, • Compensation includes hourly rate + mileage reimbursement, • Flexible field schedule based on caseload, • Private ownership with a people focused company (we often promote from within!), • Daily interaction with some of the most talented people in the medical cost-containment industry, • Want to see more? Check out our:

Job Description Overview To plan, direct and manage the day-to-day activities of assigned staff and ambulatory services operations; to assure provisions of quality patient care in a safe environment; to provide direct patient care within the scope and practice of an RN as necessary; to function as a member of an interdisciplinary team and to act as a resource to staff and the general public regarding assigned areas of responsibility. Accountable for overall management of patient care, nursing staff, and ancillary staff in the Surgical Services (i.e. AM / SDS, Pre and Post Anesthetic care, Operation Room and Central Sterile departments). Provides supervision to RNs, OR Techs, NA and ancillary staff. Directs ongoing evaluation of safety and quality of patient care. Develops annual operating and capital equipment budgets in accordance with organizational and patient care needs. Plans and controls staff and supply utilization within allocated funds. Collaborates with administrative, medical and interdisciplinary staff in the analysis and improvement of programs, systems, staff development and management of fiscal resources. Provides direct patient care as necessary. Salary: $167,000 - $210,000/yr This position is full-time, exempt and benefits eligible. Compensation is determined based on experience and department equity. Responsibilities • Communicates job duties to staff in a clear, understandable, and concise manner; plans, directs, and supervises work of assigned staff utilizing positive communications and effective problem solving skills., • Performs initial planning/review session, annual performance appraisal, and counseling, based on defined criteria and in compliance with Human Resources policies and procedures, • Consults in a timely manner with Director of Patient Care Services/Nurse Executive regarding staff performance, problems or concerns which may affect efficient and effective department operations, and facility-wide issues which may have a direct or indirect effect on department morale., • Delegates appropriate responsibility and authority to staff according to relevant job descriptions and individual capabilities., • Evaluates department staffing/scheduling requirements, taking into account requests for holiday/vacation time; recommends appropriate use of per diem staff. Provide mentoring for staff in clinical expertise, professional role modeling, and clinical direction., • Accurately documents assessments, important patient data, and plan of care., • Works effectively as a member of the Management Team to accomplish facility organizational goals, develop a strategic plan, develop a positive working relationships with the medical staff, and to develop positive interdepartmental communications regarding department programs and services., • Develops and implements a department Performance Improvement Program in compliance with the Joint Commission standards for ASC accreditation., • Maintains inventory of supplies required to provide services; assures completion of appropriate requisition forms; reviews all purchase requisitions for accuracy and appropriateness prior to approval; consults with Director of Patient Care Services/Nurse Executive as specified., • Management of Fiscal resources: Demonstrates efficient planning, monitoring, control and reporting of fiscal resource utilization. Assesses and clearly justifies departmental needs and submits annual operating budget and capital equipment according to time frames and established protocol., • Fosters and participates in a team-oriented approach to management, consistent with position. Demonstrates ability to participate in and build effective work teams and promote team-based projects., • Conducts regularly scheduled staff meetings to explain administrative and department policies, improve communications, to identify and propose resolution of problems and to plan future activities., • Ensures compliance with National Patient Safety goals and enforces policies for patient safety., • Revises department policies and procedures as needed to ensure safe clinical care., • Attends and actively participates in designated facility and departmental meetings and training classes., • Follows safety procedures, operates equipment and performs job-related duties in a safe manner which prevents accidents/injuries from occurring to self or others. Qualifications Education Bachelor’s degree (BSN) required Experience 2-5 years of previous experience in surgery, cleft lip and palate plastics, pediatric, critical care, orthopedics, and/or related areas. Previous experience in management as a charge nurse or other frontline leadership capacity. Required Active RN license in CA ACLS/BLS and PALS, required Certified Perioperative Nurse (CNOR) - preferred Shriners Children’s values diversity and provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Job DescriptionDescription: Haven Health, a well-established home health agency hiring RN's! Haven is a thriving home health agency seeking nurses that want to make a difference and be part of a team of health care professionals that are committed to quality nursing care. We provide all levels of care to patients in our community, who need our help to recover from a myriad of ailments. We specialize in complex and high-tech nursing for wound care, intravenous therapies and rehabilitation. We are located in Long Beach (Signal Hill) and service both LA and Orange Counties. All new clinical employees go through an extensive orientation process, that is based on the principals of observing, being observed and independent performance. All new employees are given the option of determining when they are ready for independent performance. We will provide all training needed and facilitate proficiency in tasks for clinical staff. So, if you're ready to help us lay the groundwork for our ever-growing well-established company, then we invite you to join our team! You will have the opportunity to learn and work alongside industry experts who have been in the healthcare field for over 20 years. RESPONSIBILITIES: • Admits patients to agency, • Provides follow up visits for patients when admissions are not available, • Coordinates admission with case manager and intake staff, • Notifies the doctor of any changes in condition and requests new orders as needed, • Advises the Director of Nursing on current events, problems, and Agency's operations on a daily basis, or as needed., • Keeps informed of new developments as related to the Agency in regard to State and Federal regulatory agencies., • Assures quality of patient care by working closely with the Utilization Review/Quality Assurance Coordinator and follows through on corrective action when appropriate., • Acts as a liaison among Agency personnel, client/client’s family members and physicians when necessary, • Attends meetings and trainings as requested or required, • Participate in on-call rotation, • Adheres to Agency's policies and procedures, • Active license the State Board of Nurses as a registered nurse., • 1 year or more as an RN preferred, • LVN experience a plus, • Ability to work independently with minimal supervision., • TB Test and Physical exam six months prior to employment or within 14 days of the date of employment and a TB thereafter annually. A chest x-ray, because of a positive TB PPD test and physicians recommendation for x-ray., • Valid Driver’s license and auto insurance, • Satisfactory references., • Spanish Speaker preferred, • Medical, Dental, and Vision Insurance, • Mileage Reimbursement, • Paid Company Holidays, • Paid Time Off

Post-Procedure Utilization Management (UM) Registered Nurse. The Post-Procedure UM RN collaborates closely with PACU staff, surgical teams, and revenue cycle partners to resolve order discrepancies, initiate status changes when appropriate, complete clinical reviews using CMS 2-Midnight, MCG, and In

As the Charge Nurse, manages the daily decisions to ensure continuity of care to maintain patient and staff safety and oversees the delivery of safe effective quality outcomes. Coordinate Charge Nurse duties with Staff RNs acting in the relief charge capacity. Complete Nurse's Technical Training Pro

Responsibilities include preparing literature reviews, conducting quantitative analyses using modeling tools/software, developing funding proposals, conducting and functionally leading research projects, organizing research findings, supervising graduate student researchers, and writing technical re

Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve supply cost goals following all guidelines established in the organization formularies.

Conducts staff meetings and oversight of staff training; provides leadership training that includes administrative and supervisory principles essential for Nurse Supervisors and Charge Nurses. Participates in the budget process; reviews invoices and manages within the budget. Participates in OBRA/PD

Performs ongoing, systematic collection and analysis of patient data pre – during – post hemodialysis treatment for assigned patients and documents in the patient medical record, makes adjustments or modifications to treatment plan as indicated and notifies Team Leader, Charge Nurse, Supervisor

Collaborate with nurses and the interdisciplinary care team.

Our client is a leading Managed Care organization (IPA) dedicated to expanding quality healthcare access.This is a non-sales, professional outreach role perfect for someone who is organized, enjoys talking to people, and wants to build a long-term career in healthcare administration.In this role, yo

Work closely with nurses, operations, and administrative staff to ensure seamless patient handoffs. Coordinate appointments, scheduling, and communication between patients, nurses, and providers.

As the Charge Nurse, manages the daily decisions to ensure continuity of care to maintain patient and staff safety and oversees the delivery of safe effective quality outcomes. Coordinate Charge Nurse duties with Staff RNs acting in the relief charge capacity. Complete Nurse's Technical Training Pro

Job Title: Registered Nurse (RN) – Wound Care Location: Los Angeles, CA 90034 Duration: 3 Months+ (Possibility of Extension) Shift Details: 08:00 AM – 04:30 PM (PST) Schedule: Monday – Friday Pay Package: Local Rate: $65/hour Travel Package: $3,100/week Job Summary: The Registered Nurse – Wo

Description The mission of the Coordinator Clinical Care is to identify high risk patients and help coordinate resources to facilitate care, improve health outcomes, and to reduce avoidable hospitalizations and re-admissions.Ultimately to provide the best quality medical care available, while worki

Current Registered Nurse License required in state of employment. Reports directly to the Campus Director of Nursing, the Campus Associate Director of Nursing, Academics (CADON, Academics) assists with providing leadership in managing and implementing a comprehensive pre-licensure registered nurse p

If you are as passionate about helping those in need as you are about growing your career, consider AltaMed.At AltaMed, your passion for helping others isn't just welcomed it's nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference.We don't just serve our comm

Provides direct nursing care including: assessment, plan of care, education, and evaluation for assigned patients.Performs patient duties necessary to maintain the flow of patient care as well as coordinates the delivery of care provided by other care team members and disciplines.PIH Health is a non