Registered Nurse II Job at Children's Hospital Los Angeles (Los Angeles)

Medical Appeals/Grievance Specialist II - Registered Nurse

Responsible for utilizing clinical acumen and managed care expertise related to ...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

1 year experience in clinical and health insurance or other healthcare related field
3 years experience in clinical and health insurance or other healthcare related field AND 1 year Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
5 years experience in clinical and health insurance or other healthcare related field AND 2 years Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
8 years experience in clinical and health insurance or other healthcare related field AND 3 years above satisfactory job performance in the managed care environment with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
Associate’s Degree in a healthcare field of study or Nursing Diploma
Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) or a compact state as a Registered Nurse (RN), a Physical Therapist (PT) or a Licensed Master Social Worker LMSW.
Intermediate PC proficiency
Intermediate skill using office equipment, including copiers, fax machines, scanner and telephones
Maintain confidentiality and privacy
Advanced clinical knowledge

Job Responsibility

Perform in-depth analysis, clinical review and resolution of provider appeals/inquiries, corrected claims and subscriber reconsiderations, member appeals, corrected claims and provider grievances for all lines of business
Identify, research, process, resolve and respond to customer inquiries primarily through written / verbal communication.
Respond to a diverse and high volume of health insurance appeal related correspondence on a daily basis.
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of appeal, grievance and reconsideration requests.
Maintain complete and accurate records per department policy.
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations.
Demonstrate ability to apply plan policies and procedures effectively.
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
Attend staff and interdepartmental meetings.
Participate in continuing education and current developments in the fields of medicine and managed care.

Fulltime

Rn per diem ii

Work within the nursing process to provide direct nursing care to assigned patie...

Location

United States , Rio Rancho

Salary:

47.38 USD / Hour

UNM Hospitals

Expiration Date

Until further notice

Requirements

Program Graduate
Nationally Accredited Nursing Graduate
1 year directly related experience
CPR for Healthcare/BLS Prov or Prof Rescuers w/in 30 days
RN in NM or as allowed by reciprocal agreement by NM

Job Responsibility

Work within the nursing process to provide direct nursing care to assigned patients consistent with clinical specialty
Serve as a role model to promote a positive work environment and quality patient care
Ensure adherence to Hospitals and departmental policies and procedures
Minimum work requirement for RN Per Diem II is four shifts per schedule
Two weekend shifts per schedule and one summer and one winter holiday are required
Deliver safe direct care to an assigned group of patients as required
Work within Hospitals, Nursing division and departmental policies
Work in collaboration with the healthcare team, implement and document individualized care plans incorporating age specific considerations, including discharge planning and patient/family teaching
Assist with special tests and procedures, ensure proper consent has been obtained
Participate in orientation

What we offer

Receive 17% Weekday Nights, 26% Weekend Nights and 15% Weekend Day shift differentials

Parttime

Registered Nurse II - Sedation

The Registered Nurse (RN) is accountable for providing competent nursing care. R...

Location

United States , Madera

Salary:

42.50 - 69.90 USD / Hour

Valley Children's Healthcare

Expiration Date

Until further notice

Requirements

Program Accredited nursing program (required)
College Degree - 4 year Nursing (preferred)
RN - Registered Nurse License - CA-BRN - California Board of Registered Nursing (required)
BLS - Basic Life Support - AHA - American Heart Association within 30 days of hire or transfer into position (required)
ACLS - Advanced Cardiac Life Support - AHA - American Heart Association Cardiac Cath Lab, Endo, Recovery, and Sedation within 12 months of hire or transfer into position (required)
PALS - Pediatric Advanced Life Support - AHA - American Heart Association Cardiac Cath Lab, Endo, Recovery, and Sedation within 12 months of hire or transfer into position (required)
Experience to correlate with Clinical Advancement Program (required)
Bilingual Skills Preferred

Job Responsibility

Providing competent nursing care
Coordination of the patient's plan of care through assessment, planning, implementation, and evaluation of nursing interventions that lead to established outcomes

Parttime

Registered Nurse II - St. Agnes Neonatal Intensive Care Unit

The Registered Nurse (RN) is accountable for providing competent nursing care. R...

Location

United States , Madera

Salary:

42.50 - 69.90 USD / Hour

Valley Children's Healthcare

Expiration Date

Until further notice

Requirements

Program Accredited nursing program (required)
College Degree - 4 year Nursing (preferred)
RN - Registered Nurse License - CA-BRN - California Board of Registered Nursing (required)
BLS - Basic Life Support - AHA - American Heart Association within 30 days of hire or transfer into position (required)
NRP - Neonatal Resuscitation Program - AHA - American Heart Association within six (6) months of hire or transfer into position (required)
Experience to correlate with Clinical Advancement Program (required)
Bilingual Skills Preferred

Job Responsibility

Coordination of the patient's plan of care through assessment, planning, implementation, and evaluation of nursing interventions that lead to established outcomes

Fulltime

Registered Nurse, Pediatric CVICU, Full Time Nights

We are looking for a Registered Nurse to join our Pediatric CVICU team at Wolfso...

Location

United States , Jacksonville

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

Requirements

Bachelor's Degree - Nursing
1-2 years Cardiac Experience Preferred
1-2 years Telemetry Experience
Hospital Experience
Basic Life Support (BLS) Required
Advanced Cardiac Life Support (ACLS) Preferred
Conscious Sedation Certification Preferred
Certified Critical Care Registered Nurse (CCRN) Preferred
Licensed Registered Nurse Required
Level II Background screening

Job Responsibility

Provide patient care to pediatric population utilizing all aspects of the nursing process
Administer medications per hospital policies and procedures
Demonstrate professionalism when interacting with others

What we offer

$5,000 Sign On Bonus

Fulltime

Clinical Informatics Registered Nurse II

The Clinical Informaticist (CI) is a clinical leader who serves as the liaison f...

Location

United States , Madera

Salary:

53.00 - 82.00 USD / Hour

Valley Children's Healthcare

Expiration Date

Until further notice

Requirements

College Degree - 4 year Nursing (required)
BLS - Basic Life Support - AHA - American Heart Association within 30 days of hire or transfer into position (required)
RN - Registered Nurse License - CA-BRN - California Board of Registered Nursing California license (required)
EPIC Certification 1 - EPIC Epic Certification necessary to support area of specialty. within 90 days of hire or transfer into position (required)
Minimum four (4) years Clinical experience (required)
Minimum two (2) years Experience and demonstrated competency with the current electronic documentation system. (required)
Ability to work with colleagues in a positive way to help reinforce changes in workflows supporting the intended use of the electronic system and avoiding system work-arounds.

Job Responsibility

Serves as the liaison for health IT efforts supporting clinical workflows and associated information systems requirements
Responsible for planning, coordinating, and monitoring the analysis, design, implementation, evaluation, and maintenance of assigned health informatics applications and projects
Partners with Nursing, clinical staff, providers, Information Technology Services (ITS), Business/Administrative Services, Project Management (OPMO/ITPMO), and other entities to successfully design, educate, implement, adopt, and sustain interoperability within clinical and non-clinical information systems
Facilitates informatics-based projects using ongoing process improvement and change management techniques
Responsible for identifying opportunities to reduce risk, improve workflows and care delivery, and diligently facilitating evidence-based, best practice and scope advocacy throughout projects, education, and technology
Facilitates, designs, development, collaboration, implementation, support, and evaluation of clinical education programs and initiatives related to Clinical Informatics and the Electronic Medical Record (EMR) in alignment with the organizational strategic plan, regulatory requirements, and clinical outcomes.

Fulltime

Clinical Research Nurse II

Under the direction of leadership, is accountable for provision of competent dir...

Location

United States of America , Rochester

Salary:

35.35 - 45.96 USD / Hour

University of Rochester

Expiration Date

Until further notice

Requirements

Associate's degree in Nursing and 6 months experience as a Registered Nurse working in an Acute Care Setting required
RN - Registered Nurse - State Licensure and/or Compact State Licensure NYS Licensure as a Registered Nurse upon hire required
Successful completion of orientation at the unit level required

Job Responsibility

Performs and documents patient care, medication administration, care plans, and patient education
Identifies patient problems and collaborates in developing a plan of care
Implements age-specific, culturally, and spiritually competent nursing interventions
Evaluates basic and complex patient/family response to procedures, therapies, and medications
Recognizes changes in patient status and responds effectively
Communicates change in patient status to appropriate members of the care team
Maintains positive relationships with all members of the healthcare team
Resolves conflict positively and in a timely manner
Treats patients, family, and staff with kindness, courtesy, and respect
Communicates effectively in written, verbal, and non-verbal interactions

Fulltime

New

Clinical Registered Nurse II-EmPATH-LGH-PT/Days

The Clinical Registered Nurse (RN) II is responsible for managing individualized...

Location

United States , Lynchburg

Salary:

Not provided

IntelyCare

Expiration Date

Until further notice

Requirements

Diploma or Associate Degree in Nursing
At least One Year of Nursing (RN) Experience
Registration as a registered nurse in the Commonwealth of Virginia and/or holds a compact license to practice in Virginia
Basic Life Support
Additional Specialty Requirements After Hire Date According to Department Standards – Advanced Cardiac Life Support

Job Responsibility

Conducts an individualized patient assessment, prioritizing the data collection based on the patient’s immediate condition or needs within timeframe specified by policies, procedures or protocols
Conducts ongoing assessments as determined by patient’s condition and/or the policies, procedures or protocols and reprioritizes care accordingly
Integrates nursing interventions into the multidisciplinary plan of care, incorporating appropriate standards of care and practice and patient outcomes
Develops, modifies, and integrates an individualized care plan which incorporates the medical plan of care, key elements from the plans of other disciplines, and standards of care and practice
Establishes individualized, measurable patient goals in consultation with the patient, family, and health care team
Performs appropriate treatments as ordered by provider in an accurate and timely manner
Performs therapeutic nursing interventions as established by individualized plan of care for the patient and his/her family
Recognizes potential problems and responds to general information/data indicating urgent and/or emergent risk to the patient
Initiates emergency resuscitative measures as appropriate
Assumes responsibility and accountability for effectively managing the care of a specialty patient population

Fulltime

Registered Nurse II

Children's Hospital Los Angeles

Location:
United States , Los Angeles

Category:
Nursing

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
March 04, 2026

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