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DHCS Cert Nurse Reviewer RN-PD - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Pasadena, CA Pasadena, California |
About this job
Under the direction of the Manager - Regulatory Medi-Cal Certification Programs, RN, performs Department of Health Care Services (DHCS) Facility Site Reviews (FSR), Medical Record Reviews (MRR) and Physical Assessment Reviews (PAR) in compliance with DHCS Medi-Cal Managed Care Division, (MMCD). This involves ensuring through Site Reviews and Audits that the care delivery locations where employees and physicians provide care to MMCD members meet all requirements for certification through DHCS.
Essential Responsibilities:
This is a telecommuting position, candidates must reside within the Los Angeles County area and are required to travel up to 85% of the time to various Kaiser Permanente Clinics throughout Southern California.Independently schedule and perform the DHCS MMCD Facility Site Review (FSR), Medical Record Review (MRR), and Physical Accessibility Review (PAR) surveys as assigned throughout Southern California, predominantly Los Angeles, Kern, San Bernardino, and Riverside counties. Travel may include Orange and San Diego counties as needed.Ensure the performance of all FSR surveys conducted is in accordance with DHCS - MMCD and Plan Partner requirements.Perform all FSR correspondence and is completed in accordance with established policy and procedure.Report all FSR findings to appropriate providers, departments and Regulatory Medi-Cal Certification Manager.Issue corrective action plans (CAP) when necessary, report CAP to Regulatory Medi-Cal Certification Manager, and ensure CAPs are closed timely.Ensure submission of FSR / MRR / PARs are submitted to Regulatory Medi-Cal Certification Manager WeeklyAttend all required FSR training, State and/or Plan Partner, as required to maintain current level of Site Reviewer certification (CSR, DPT, CMT)Maintain California Board of Registered Nursing RN license and DHCS-MMCD Certified Site Reviewer, Designated Plan Trainer or Certified Site Reviewer certification.Professional Competencies: Demonstrates technological literacy in using computerized information systems. Accesses, evaluates and uses data and information from a wide range of resources. Demonstrates effective use of computer-based information and practice management systems for decision support, provision of care, continuous quality improvement and professional development.Applies effective oral and written communication skills in interacting with members of the health care team including critical thinking, influencing, problem solving, and analytical skills.Proficient in Excel and Word applications.
Basic Qualifications:
Experience
Minimum one (1) year of RN experience in acute care or ambulatory care/clinic setting.Minimum one (1) year of RN experience as a DHCS Certified Site Reviewer, DHCS Designated Trainer or DHCS Certified Master Trainer.
Education
Associates degree in Nursing
License, Certification, Registration
Current DHCS/MMCD Certified Site Reviewer Certificate or higherCurrent CA RN license
Additional Requirements:
Strong working knowledge of federal/state laws and regulations related to the Department of Healthcare Services (DHCS) regulations for Medi-Cal and the MMCD program.Demonstrated critical thinking, influencing, problem solving, and analytical skills.Ability to foster a customer oriented work environment with emphasis on dedication to helping customers, respect for individuals, highest standards of quality, innovation, empowerment, and teamwork.Must be able to work in a Labor / Management Partnership environment.
Preferred Qualifications:
One year or more work experience in a primary care setting (family medicine, internal medicine or pediatrics).Bachelor's Degree preferred
Essential Responsibilities:
This is a telecommuting position, candidates must reside within the Los Angeles County area and are required to travel up to 85% of the time to various Kaiser Permanente Clinics throughout Southern California.Independently schedule and perform the DHCS MMCD Facility Site Review (FSR), Medical Record Review (MRR), and Physical Accessibility Review (PAR) surveys as assigned throughout Southern California, predominantly Los Angeles, Kern, San Bernardino, and Riverside counties. Travel may include Orange and San Diego counties as needed.Ensure the performance of all FSR surveys conducted is in accordance with DHCS - MMCD and Plan Partner requirements.Perform all FSR correspondence and is completed in accordance with established policy and procedure.Report all FSR findings to appropriate providers, departments and Regulatory Medi-Cal Certification Manager.Issue corrective action plans (CAP) when necessary, report CAP to Regulatory Medi-Cal Certification Manager, and ensure CAPs are closed timely.Ensure submission of FSR / MRR / PARs are submitted to Regulatory Medi-Cal Certification Manager WeeklyAttend all required FSR training, State and/or Plan Partner, as required to maintain current level of Site Reviewer certification (CSR, DPT, CMT)Maintain California Board of Registered Nursing RN license and DHCS-MMCD Certified Site Reviewer, Designated Plan Trainer or Certified Site Reviewer certification.Professional Competencies: Demonstrates technological literacy in using computerized information systems. Accesses, evaluates and uses data and information from a wide range of resources. Demonstrates effective use of computer-based information and practice management systems for decision support, provision of care, continuous quality improvement and professional development.Applies effective oral and written communication skills in interacting with members of the health care team including critical thinking, influencing, problem solving, and analytical skills.Proficient in Excel and Word applications.
Basic Qualifications:
Experience
Minimum one (1) year of RN experience in acute care or ambulatory care/clinic setting.Minimum one (1) year of RN experience as a DHCS Certified Site Reviewer, DHCS Designated Trainer or DHCS Certified Master Trainer.
Education
Associates degree in Nursing
License, Certification, Registration
Current DHCS/MMCD Certified Site Reviewer Certificate or higherCurrent CA RN license
Additional Requirements:
Strong working knowledge of federal/state laws and regulations related to the Department of Healthcare Services (DHCS) regulations for Medi-Cal and the MMCD program.Demonstrated critical thinking, influencing, problem solving, and analytical skills.Ability to foster a customer oriented work environment with emphasis on dedication to helping customers, respect for individuals, highest standards of quality, innovation, empowerment, and teamwork.Must be able to work in a Labor / Management Partnership environment.
Preferred Qualifications:
One year or more work experience in a primary care setting (family medicine, internal medicine or pediatrics).Bachelor's Degree preferred