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:  5145

 

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 in five health plans, 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 Nurse Specialist RN II conducts 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. Conducts various types of site reviews of PCP and specialist sites to ensure quality FSR and physician compliance with Local, State, and Federal requirements. 

Duties

Conducts Full Scope Reviews, Site Review Surveys, Medical Record Review Surveys, Specialty Site Review Surveys, PARS assessments, Focused Reviews, Interim Onsite Reviews, Consultation/Educational Site visits, Investigative visits, HEDIS related visits, and/or other appropriate site visits.

 

Conducts face-to-face visits with our high-membership physician sites to include the following: Provider feedback to providers on performance on HEDIS-related measures and incentives performance; give providers health education materials and clinical tools to facilitate improved screening, preventive care, and chronic disease management; promote clinical quality improvements in practices; and document outcomes and issues of site visits for review and data gathering to the FSR Manager.

 

Act as the provider quality improvement liaison (PQIL) to assess and communicate issues and improvement opportunities identified during the physician site visit to the FSR Manager for resolution and a plan of action.  Information gathered from provider sites will be submitted as a report and discussed with the FSR Manager at least bimonthly as appropriate.

 

Communicates and coordinates information and findings from site visits between FSR Manager, internal and external staff and customers. Documents discussions and correspondence in FSR file as appropriate.

 

Assists and participates in the facilitation of disease management programs as implemented by the Quality Improvement (QI) department. Assists and participates in the Annual Audit of Plan Partners delegated for FSR.

 

Performs other duties as assigned.

Education Required
Associate's Degree in Nursing
Education Preferred
Bachelor's Degree in Nursing
Experience

Required:
At least 5-7 years of clinical experience including, but not limited to ER/Acute care nursing or outpatient setting.

 

Preferred:  
Medi-Cal managed care auditing experience.

 

At least one (1) year experience in Quality Improvement and 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
Certified Site Reviewer
Active & Current Driver's License, with a clean record and Auto Insurance Required
Licenses/Certifications Preferred
Certified Professional in Healthcare Quality (CPHQ)
Required Training
Additional Information

Required: 
Must obtain and maintain successful completion of a DHCS Certified Site Reviewer and/or DHCS Certified Trainer certification in order to conduct DHCS accepted audits independently within 6 months of date of hire in the position.

 

Preferred:
Certified Professional in Healthcare Quality (CPHQ)  and Department of Health Care Services (DHCS).

 

RN Reviewer or Trainer certification.

 

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)


Nearest Major Market: Los Angeles

Job Segment: Nursing, Medical, Registered Nurse, Healthcare