Job Information
L.A. Care Health Plan Facility Site Review Nurse Specialist RN II in Los Angeles, California
Facility Site Review Nurse Specialist RN II
Job Category: Clinical
Department: Facility Site Review
Location:
Los Angeles, CA, US, 90017
Position Type: Full Time
Requisition ID: 11628
Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
Job Summary
The Facility Site Review (FSR) Nurse Specialist RN II conducts Full Scope Reviews, Site Review Surveys, Medical Record Review Surveys, Specialty Site Review Surveys, physical accessibility review survey (PARS) assessments, Focused Reviews, Interim Onsite Reviews, Consultation/Educational Site visits, Investigative visits, and/or other appropriate site visits to ensure quality FSR and physician compliance with Local, State, and Federal requirements. The FSR Nurse Specialist RN II may also conduct face-to-face visits with our high-membership physicians to provide feedback, data, and education on programs and facilitates changes to improve quality of care and service to members.
Duties
Conducts audits utilizing Department of Health Care Services (DHCS) FSR/MRR/PARS tools. Provides pre-audit and /or post audit educational sessions. Issue Corrective Action Plans (CAPs) and provide assistance or follow up in implementing adequate correction(s) on-site.
Gives providers health education materials and clinical tools to facilitate improved screening, preventive care, and chronic disease management; promote clinical quality improvements in practices.
Acts as the Provider Quality Improvement Liaison (PQIL) to assess and communicate issues and improvement opportunities identified during the physician site visit.
Communicates and coordinates information and findings from site visits between FSR Manager, internal and external staff and provider sites. Documents discussions and correspondence in FSR file as appropriate.
Assists and participates in the Annual Audit of Plan Partners delegated for FSR.
Perform other duties as assigned.
Duties Continued
Education Required
Associate's Degree in Nursing
Education Preferred
Bachelor's Degree in Nursing
Experience
Required:
At least 5 years of clinical experience including, but not limited to Emergency Room (ER)/Acute care nursing or outpatient setting.
Preferred:
Medi-Cal managed-care auditing experience.
At least one (1) year experience in Quality Improvement and/or familiar with DHCS audit tool.
Skills
Required:
Excellent verbal and written communication skills.
Excellent organizational and time-management skills.
Proficient in Microsoft Office.
Licenses/Certifications Required
Registered Nurse (RN) - Active, current and unrestricted California License
Must obtain and maintain successful completion of a DHCS Certified Site Reviewer certification in order to conduct DHCS accepted audits independently within 8 months of date of hire in the position.
Licenses/Certifications Preferred
Department of Health Care Services (DHCS) Certified Site Reviewer
Required Training
1:1 on-site and/or virtual training with Certified Site Reviewers (CSRs) until certification is obtained. Minimum of 8 months.
Physical Requirements
Light
Additional Information
Required:
Travel to offsite locations for work.
Travel is required 80% of time.
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including
Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)