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Kaiser Permanente Careers

Quality Assurance, UR & Case Management

Passion + Vision + Integrity = Excellence

Ensure consistency and the highest ethical standards across our entire organization. Our quality assurance team drives ongoing improvement by fostering an environment of support, providing technical and specialized consultative services, and inspiring ongoing excellence.

DHCS Certified Nurse Reviewer RN

Location: Pasadena, CA Additional Locations:
Job Number: 854745 Date posted: 01/13/2020
Description:
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, prefer candidates to reside within the Los Angeles County area and are required to travel up to 75% of the time to various Kaiser Permanente Clinics throughout Southern California. Travel may include Orange and San Diego counties as needed.
  • 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. 
  • 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 Weekly
  • Attend 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. Power Point experience also preferred.
  • 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 higher
  • Current 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
  •  

    Notes:

    Located in Pasadena, Walnut Center or Telecommuting position. At times will commute between Bakersfield and San Diego.

    Primary Location: California,Pasadena,Regional Offices-Walnut 393 E. Walnut St. Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon-Fri Working Hours Start: 8:00AM Working Hours End: 4:00PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Non-Union, Non-Exempt Job Level: Individual Contributor Job Category: QA / UR / Case Management Department: AR&L Travel: Yes, 75 % of the Time Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

    About QA, Ur & Case Management Careers

    Careers In QA, Ur & Case Management

    As an organization, we are committed to delivering the same exemplary care no matter who you are, where you are, or what your needs. But how are those standards defined, measured, and assessed? That's where our quality assurance team comes in. Implementing the action plans and initiatives that will drive successful practices, you'll work across the organization to foster the necessary education, communication, and innovation that will enable us to operate as one KP — with our mission and goals in complete alignment.

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