Quality Management Nurse Specialist RN II Job at L.A. Care Health Plan (Los Angeles)

Utilization Management Nurse Specialist RN II

The Utilization Management Nurse Specialist RN II facilitates, coordinates, and ...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
At least 5 years of varied RN clinical experience in an acute hospital setting
At least 2 years of Utilization Management/Case Management experience in a hospital or HMO setting
Registered Nurse (RN) - Active, current and unrestricted California License
Must be computer literate, with expertise in Outlook, Word, Excel, PowerPoint
Provision of excellent customer service
Excellent time management and priority-setting skills
Maintains strict member confidentiality and complies with all HIPAA requirements
Strong verbal and written communication skills

Job Responsibility

Facilitates, coordinates, and approves medically necessary referrals that meet established criteria
Assures timely and accurate determination and notification of referrals and reconsiderations based on the referral determination status
Generates approval, modification and denial communications, to include member and provider notification of referral determination
Actively monitors for admissions in any inpatient setting
Performs telephonic and/or onsite admission and concurrent review, and collaborates with onsite staff, physicians, providers, member/family interaction to develop and implement a successful discharge plan
Works with the UM Manager and Physician Advisor on case reviews for pre-service, concurrent, post-service and retrospective claims medical review
Monitors and oversees the collection and transfer of data (medical records) and referral requests by Providers
Acts as a department resource for medical service requests /referral management and processes
Receives incoming calls from providers, professionally handles complex calls, researches to identify timely and accurate resolution steps
Follows up with caller to provide response or resolution steps

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Utilization Management Nurse Specialist RN II

The Utilization Management Nurse Specialist RN II facilitates, coordinates, and ...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
At least 5 years of varied RN clinical experience in an acute hospital setting
At least 2 years of Utilization Management/Case Management experience in a hospital or HMO setting
Must be computer literate, with expertise in Outlook, Word, Excel, PowerPoint
Excellent time management and priority-setting skills
Strong verbal and written communication skills
Registered Nurse (RN) - Active, current and unrestricted California License

Job Responsibility

Facilitates, coordinates, and approves medically necessary referrals that meet established criteria
Assures timely and accurate determination and notification of referrals and reconsiderations
Generates approval, modification and denial communications
Actively monitors for admissions in any inpatient setting
Performs telephonic and/or onsite admission and concurrent review
Collaborates with onsite staff, physicians, providers, member/family to develop and implement a successful discharge plan
Works with the UM Manager and Physician Advisor on case reviews
Monitors and oversees the collection and transfer of data (medical records) and referral requests by Providers
Acts as a department resource for medical service requests /referral management and processes
Receives incoming calls from providers, professionally handles complex calls

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Utilization Management Nurse Specialist RN II

The Utilization Management Nurse Specialist RN II facilitates, coordinates, and ...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
At least 5 years of varied RN clinical experience in an acute hospital setting
At least 2 years of Utilization Management/Case Management experience in a hospital or HMO setting
Registered Nurse (RN) - Active, current and unrestricted California License
Must be computer literate, with expertise in Outlook, Word, Excel, PowerPoint
Provision of excellent customer service required
Excellent time management and priority-setting skills
Maintains strict member confidentiality and complies with all HIPAA requirements
Strong verbal and written communication skills

Job Responsibility

Facilitates, coordinates, and approves medically necessary referrals that meet established criteria
Assures timely and accurate determination and notification of referrals and reconsiderations
Generates approval, modification and denial communications
Actively monitors for admissions in any inpatient setting
Performs telephonic and/or onsite admission and concurrent review
Collaborates with onsite staff, physicians, providers, member/family to develop and implement a successful discharge plan
Works with the UM Manager and Physician Advisor on case reviews
Monitors and oversees the collection and transfer of data (medical records) and referral requests by Providers
Acts as a department resource for medical service requests /referral management and processes
Receives incoming calls from providers, professionally handles complex calls

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Care Management Specialist II, D-SNP Team

The Care Management Specialist II utilizes clinical skills and training to perfo...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing for Registered Nurses OR Master's Degree in Social Work for Licensed Clinical Social Workers
Minimum of 3 years of recent care management experience with responsibilities of managing complex acute or chronic conditions in collaboration with members and interdisciplinary care professionals in a hospital, medical group or managed care setting, such as a health insurance environment and/or experience as care manager in home health or hospice environments
Experience providing care management with complex/catastrophic conditions
Current knowledge of clinical standards of care and disease processes
Critical thinking skill
Excellent customer service skills
Ability to clinically analyze the most complex cases involving highly acute physical health, behavioral health, complex/catastrophic and/or psychosocial issues to determine and implement the most effective member-centered interventions
Ability to triage immediate member health and safety risks
Ability to sensitively manage member or family responses associated with high acuity cases and support effective coping
Strong verbal and written communications skills to consult effectively with interdisciplinary teams, coordinate care with members and their families, and other internal and external stakeholders

Job Responsibility

Utilizes clinical skills and training to perform essential functions of care management for identified and assigned member population according to Health Insurance Portability and Accountability Act (HIPAA) guidelines
Manages a specified caseload across the entire continuum of programmatic levels including those within National Committee for Quality Assurance (NCQA) scope or otherwise Complex/Catastrophic cases
Management of the caseload assigned by Manager includes: coordinating health care benefits, providing education and facilitating member access to care in a timely and cost-effective manner
Collaborates and communicates with member, family, and interdisciplinary health team to promote wellness and member empowerment, while ensuring access to appropriate services across the healthcare continuum and maximizing member benefit
Serves as clinical advocate for members, active interdisciplinary team member, liaison with other departments and external health care team
Provides direction and assistance to Care Coordinators and to Community Health Workers (CHW) of members needs including the need for special educational mailings, reminder calls, satisfaction surveys, incentives or any additional service needs according to specific program guidelines
Uses claims processing and care management software to look up member information, document contacts, and track member progress
Applies clinical knowledge and experience to evaluate information regarding prospective care management members referred by health risk assessment (HRA), risk stratification, predictive modeling, provider’s utilization review vendors, members, Call Center, claims staff, Health Homes Program (HHP) eligibility or other data sources to determine whether care management intervention is necessary to meet the member's needs
Conducts Care Management services for the most complex and vulnerable members including: engaging in member centric communication which includes the interdisciplinary team, providers and family or authorized representatives
reviewing member claims histories and identifies intervention opportunities through the professional standards of practice

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Staff Accountant

Robert Half is looking for a Staff Accountants for contract position within the ...

Location

United States , Minneapolis

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Strong proficiency in Excel
Strong analytical skills, accuracy and attention to detail
Strong organizational, written and verbal communication skills
Ability and willingness to meet business critical deadlines

Job Responsibility

Prepare journal entries, monthly and year-end closings, bank reconciliations, fixed asset maintenance and general ledger reconciliation
Perform month-end close including preparing complex journal entries and account reconciliations, prepaid expenses and payroll
Prepare monthly balance sheet and income statement analysis for management reporting
Assist in the month-end, quarter-end and year-end closing process including monthly financial close workbook preparation
Maintain fixed asset ledger, depreciation, and reconciliations
In-depth experience with month-end balance sheet account reconciliations

What we offer

Medical, vision, dental, and life and disability insurance
401(k) plan

Receptionist

We are seeking a friendly, polished, and organized Receptionist to serve as the ...

Location

United States , Minneapolis

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

High school diploma or equivalent required
1+ years of receptionist, front desk, customer service, or administrative experience preferred
Proficiency in Microsoft Office, including Word, Outlook, and Excel
Excellent verbal and written communication skills
Strong organizational skills and attention to detail
Ability to multitask and maintain professionalism in a busy environment

Job Responsibility

Greet and assist visitors, clients, and employees in a professional and courteous manner
Answer, screen, and direct incoming phone calls
Manage the front desk and maintain a welcoming office environment
Handle incoming and outgoing mail, packages, and deliveries
Schedule appointments, meetings, and conference rooms
Maintain visitor logs and support office security procedures
Perform data entry, filing, and other administrative support tasks
Assist with office supply inventory and ordering
Support internal teams with general clerical and administrative duties

What we offer

Medical insurance
Vision insurance
Dental insurance
Life insurance
Disability insurance
401(k) plan

Fulltime

Controller

We are looking for an experienced Controller to lead financial operations and pr...

Location

United States , Saint Peter

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Bachelor’s degree in Accounting or a closely related field
CPA designation required
At least 10 years of progressive accounting and finance experience, including leadership responsibility
Prior experience in a Controller or comparable financial management role
Strong command of GAAP and applicable accounting regulations
Demonstrated background in full-cycle accounting, general ledger management, and month-end close processes
Experience overseeing audited financial statements, grant accounting, and supervisory responsibilities

Job Responsibility

Direct daily financial operations across accounting, payroll, accounts payable, fixed assets, and fund accounting activities
Manage the preparation and filing of required tax documents, regulatory submissions, and other government reports within established deadlines
Oversee investment accounting and restricted fund reporting to maintain accuracy, transparency, and compliance
Lead annual financial statement audits and related government audits, serving as the main contact for external auditors and coordinating follow-up actions
Strengthen internal controls, review financial workflows, and implement procedures that reduce risk and support policy compliance
Monitor liquidity levels, forecast cash needs, and recommend effective use of excess funds to support financial stability
Partner with leadership teams, committees, and cross-functional groups to provide financial guidance for planning and decision-making
Promote responsive service and strong collaboration between the finance function and departments throughout the organization
Carry out additional finance leadership duties as needed to support operational and strategic priorities

What we offer

Medical, vision, dental, and life and disability insurance
Enrollment in company 401(k) plan

Fulltime

Benefits Specialist

We are looking for a Benefits Specialist to support benefits administration and ...

Location

United States , Bridgewater

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Prior experience administering employee benefits, including direct involvement in open enrollment activities
Working knowledge of compliance considerations related to benefits documentation and employee elections
Proficiency with spreadsheets and comfort using them for data review, tracking, and uploads
Experience working in HRIS such as ADP or Workday or benefits administration platforms to manage employee records and reporting
Strong accuracy and proofreading skills, especially when reviewing manual data entry
Ability to work independently on administrative assignments with minimal ramp-up time
Effective communication skills for assisting employees with benefit updates and system navigation

Job Responsibility

Coordinate day-to-day benefits administration tasks with a focus on supporting the open enrollment period for the upcoming plan year
Review employee benefit elections and related documentation to help ensure records are complete, accurate, and aligned with established policies
Enter and validate benefits data in HR and benefits systems, checking manual updates carefully to reduce errors
Assist staff members with self-service benefit changes by providing clear guidance through online enrollment tools when needed
Prepare and maintain spreadsheets for data tracking, reporting, and file uploads tied to benefits activity
Support enrollment changes associated with updated carrier offerings and revised plan options during the enrollment cycle
Monitor handling of electronic and paper forms to help maintain compliance with benefits administration standards
Partner with internal stakeholders to address employee questions and resolve routine benefits-related issues efficiently

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

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Quality Management Nurse Specialist RN II

Job Description

Job Responsibility

Requirements

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