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<p>Salary Range:&nbsp;&nbsp;$67,186.00&nbsp;(Min.) -&nbsp;$87,342.00&nbsp;(Mid.) -&nbsp;$107,498.00&nbsp;(Max.)</p><p>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.<br><br>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.<br></p><h4>Job Summary</h4><p>The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and approve medically necessary referrals that meet established criteria. Assures timely and accurate determination and notification of referrals and reconsiderations based on the referral determination status. Generates approval, modification and denial communications to include member and provider notification of referral determination. Actively monitors for admissions in any inpatient setting. Performs telephonic and/or on site admission and concurrent review, and collaborates with onsite staff, physicians, providers, member/ family interaction to develop and implement a successful discharge plan. </p><p>Works with the UM Manager and Physician Advisor on case reviews for pre-service, concurrent, post-service and retrospective claims medical review. Monitors and oversees the collection and transfer of data (medical records) and referral requests by Providers. Acts as a department resource for medical service requests /referral management and processes. Receives incoming calls from providers, professionally handles complex calls, researches to identify timely and accurate resolution steps. Follows up with caller to provide response or resolution steps. Answers all inquiries in a professional and courteous manner.</p><h4>Duties</h4><p>Promote and support team engagements, programs and activities to create and ensure a positive and productive workplace environment.</p><p>Perform prospective, concurrent, post-service and retrospective claim medical review processes. Utilizing considerable clinical judgement, independent analysis, critical-thinking skills and detailed knowledge and application of medical policies, clinical guidelines and benefit plans to complete reviews and determinations within required turnaround times specific to the case type. Identifies cases needing Physician Advisor (PA) review or input and presents for physician review if indicated.</p><p>Perform telephonic and/or on site admission and concurrent review, and collaborates with onsite staff, physicians, providers, the member and significant others to develop and implement a successful discharge plan. Process, finalize and facilitate Inbound requests received from providers. </p><p>Generate appropriate member and provider communication for all determinations within the required timelines as defined by the most current department policy.</p><p>Facilitate/review requests for Higher level of care or skilled nursing/discharge planning needs.&nbsp; Research for appropriate facilities, specialty providers and ancillary providers to utilize for all lines of business. Identification of potential areas of improvement within the provider network.</p><p>Identify and initiates referrals for appropriate members to the various L.A. Care programs/processes and external community based programs or Linked and Carve Out Services (e.g. DDS/CCS/MH). Ensure potential quality of care/potential fraud issues are identified and documented per L.A. Care policy. Ensure high risk/high cost cases and reports are maintained and referred to the Physician Advisor/UM Director. </p><p>Documents in platform/system of record. Utilizes designated software system to document reviews and or notes.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </p><h4>Duties Continued</h4><h4>Participate in the department’s continuous quality improvement activities. Communicates to UM Manager and supervising RN, barriers to completing assignments or daily work in an efficient and effective manner.</h4><h4>Receive incoming calls from providers, professionally handles complex calls, researches to identify timely and accurate resolution steps. Follows up with caller to provide response or resolution steps. Answers all inquiries in a professional and courteous manner.</h4><p>Perform other duties as assigned.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p><h4>Education Required</h4>Associate's Degree<h4>Education Preferred</h4>Bachelor's Degree<h4>Experience</h4><p>Required:</p><p>At least 4 years of experience in a patient care setting and/or combination in utilization management, appeals and grievances, delegation oversight, and/or CNA experience. </p><p>At least 2 years of Utilization Management/Case Management experience in a hospital or HMO setting.</p><p>Preferred:&nbsp; </p><p>Managed Care experience performing UM and CM at a medical group or management services organization. Experience with Managed Medi-Cal, Medicare, and commercial lines of business.</p><h4>Skills</h4><p>Required:</p><p>Technical skills: Must be computer literate, with expertise in Outlook, Word, Excel, and PowerPoint.&nbsp; Effectively utilize computer and appropriate software and interacts as needed with L.A. Care Information System. </p><p>Customer Service Skills: Provision of excellent customer service required due to frequent communication with providers and other members of the interdisciplinary team.</p><p>Excellent time management and priority-setting skills.</p><p>Maintains strict member confidentiality and complies with all HIPAA requirements.</p><p>Strong verbal and written communication skills.</p><p>Preferred:</p><p>Knowledge of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or CM. </p><p>Knowledge of Department of Health Care Services (DHCS) or Centers for Medicare and Medicaid Services(CMS) requirements for health plan compliance with UM or CM.</p><h4>Licenses/Certifications Required</h4>Licensed Vocational Nurse (LVN) - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4>Case Management Certificate<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>May work on occasional weekends and some holidays depending on business needs.</p><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul>

L.A. Care Health Plan

Utilization Management Nurse Specialist LVN II

<br>                                                Job description                                                                                                                                        <p>#LI-DL2 #HSBCUSA&nbsp;</p><p>We support the builders, forward-thinkers, future-makers and leap-takers, helping them ignite the bold ideas that reshape our world. We offer flexible banking solutions for start-ups, scale-ups, growth businesses, investors and those working towards IPO.</p><p>Whether it’s providing strategic advice, comprehensive banking, industry connections or creative and bespoke capital solutions, we power ideas at every stage of their journey. From the first-time founders to the funds that back them and everything in between. We're proud to accelerate growth for tech and life science businesses, create meaningful connections and open a world of global opportunity for entrepreneurs and investors alike.</p><p>The Opportunity – Vice President/Director, Relationship Banking </p><p>As our business continues to grow we are looking for an experienced professional to join our HSBC Innovation Banking Life Sciences &amp; Healthcare Banking practice in San Francisco. This is an exciting opportunity to help grow the business in the Innovation market and to partner with the next generation of builders. &nbsp;</p><p>The role is focused on building deep relationships with the founders and CEOs of new and scaling Life Sciences &amp; Healthcare companies. The team is focused on companies in the Life Sciences &amp; Healthcare and Innovation Sectors and you should have relevant experience with high growth companies in the healthtech, biopharma, medical device, tools, and diagnostic sectors. By working closely with these teams, you will build trusted relationships with these companies leveraging HSBC’s Innovation Banking platform to help them grow.&nbsp;</p><p>You will build effective internal networks with multiple teams across all of HSBC, particularly our colleagues in Innovation Lending, Relationship Advisors, Product Advisors and internal operations to provide a streamlined banking experience for the client.&nbsp;</p><p>What you’ll be doing</p><ul><li>Building deep, long-term relationships with the founders and finance leaders of growing Life Sciences &amp; Healthcare companies&nbsp;</li><li>Deliver the breadth and depth of the HSBC Innovation Banking Platform</li><li>Developing relationships with Venture Capitalists, Advisors and finance partners who work with companies within the Technology and Innovation Sectors&nbsp;</li><li>Generating new business for HSBC Innovation Banking through banking products and identifying opportunities to support companies with lending and credit products&nbsp;</li><li>Developing the HSBC Innovation Banking brand by both creating and being in the market at industry events and conferences and creating high quality media, speaking and thought leadership opportunities&nbsp;</li><li>Building effective internal networks within the HSBC Innovation Banking platform to enable full success in the role&nbsp;</li><li>Providing insight into the HSBC Innovation Banking platform on key industry and company trends to ensure HSBC Innovation Banking is developing its business to meet the needs of the innovative ecosystem</li></ul><p>For this role, HSBC targets a fixed pay range between $175,000.00 and $250,000.00.</p><p>The final fixed pay offer will depend on the candidate and a number of variables, including but not limited to, role responsibilities, skill set, depth of experience and education, licensing/certification requirements, internal relativity, and specific work location.</p><p>At HSBC, our overall goal is to provide a competitive Total Reward Package, with an appropriate mix of fixed pay, and variable pay, as part of an employee’s overall total compensation and benefits. Variable pay generally takes the form of discretionary, annual awards (sometimes referred to as a “bonus”). Additionally, HSBC offers a wide range of competitive and flexible benefits designed to help you improve your health and well-being, finances, and lifestyle.</p>                                                                                                                                    Requirements                                                                                                                                        <p>In compliance with applicable laws, HSBC is committed to employing only those who are authorized to work in the US. Applicants must be legally authorized to work in the U.S. as HSBC will not engage in immigration sponsorship for this position. </p><ul><li>8+ Years of relevant technology ecosystem experience&nbsp;</li><li>Entrepreneurial,&nbsp;extremely self-motivated, and success driven&nbsp;</li><li>Long-term, authentic relationship building skills and proven origination skills to build a high-quality client portfolio&nbsp;</li><li>Preference for candidates with experience working in the venture capital and start-up ecosystem&nbsp;</li><li>Expert Relationship Management skills with companies within the Life Sciences &amp; Healthcare and Innovation Sectors&nbsp;</li><li>Strong finance, analysis and commercial lending experience, including the ability to understand and negotiate credit terms&nbsp;</li><li>Excellent all-round knowledge of banking products, including Treasury, Clearing and Trade Finance Solutions&nbsp;</li><li>Strong background in debt structuring and execution</li><li>Passionate about technology start-ups and the venture ecosystem&nbsp;</li></ul><p>You should have an entrepreneurial, collaborative approach, and a flexible style that allows for the input of others. It’s a must that you share the core values of HSBC Innovation Banking and be focused on long term outcomes with a proven track record of delivering results.&nbsp;This role will be based in San Francisco, CA. </p><p>As an HSBC employee, you will have access to tailored professional development opportunities to ensure you have the right skills for today and tomorrow. We offer a competitive pay and benefits package including a robust Wellness Hub, all in a welcoming, diverse and inclusive work environment.&nbsp; You will be empowered to drive HSBC’s engagement with the communities we serve through an industry-leading volunteerism policy, a generous matching gift program, and a comprehensive program of immersive Sustainability and Climate Change Initiatives. You’ll want to join our Employee Resource Groups as they play a central part in life at HSBC, including the development of our employees and networking inside and outside of HSBC.&nbsp; We value difference. We succeed together. We take responsibility. We get it done. And we want you to help us build the bank of the future!</p><p>All qualified applicants will receive consideration for employment without regard to age, ancestry, color, race, national origin, ethnicity, disability or medical condition, genetic information, military or veteran service, religion, creed, sex, gender, pregnancy, childbirth, caregiver status, marital status, citizenship or immigration status, sexual orientation, gender identity or expression or any other trait protected by applicable law.</p>

HSBC

Vice President, Relationship Manager - Healthcare and Life Science - Innovation Banking

<p>Job Description:</p><p>POSITION SUMMARY</p><p>The Enrollment Counselor position at Pacific Oaks supports all recruitment, admissions, and advising efforts at the college. Additionally, it helps with activities by handling communications, information and paper flow with prospective and admitted students. The successful candidate will be an articulate, organized, results driven, a dynamic and enthusiastic leader, and a team player.</p><p>This position is located in Pasadena and reports directly to the AVP of Admissions.</p><p>ESSENTIAL JOB FUNCTIONS:</p><ul><li>Provide excellent customer service to prospective students throughout the full admission recruitment process</li><li>Meet daily expectations for outbound dials, set campus consultations</li><li>Meet with prospective students to counsel on completing Admissions requirements, discusses academic programs, admission options, and financial aid opportunities and conducts campus tours.</li><li>Meet/exceed Admission benchmark goals</li></ul><p>JOB FUNCTIONS:</p><ul><li>Availability to work evening shifts and a rotating Saturday shift as needed</li><li>Follow up with prospects and applicants by phone and written correspondence.</li><li>Plan and coordinate on-campus Information Sessions and Open Houses for prospective students</li><li>Regularly attends the school department staff meetings</li><li>Assist new and continuing students with registration process</li><li>Follow up with admitted/current students to ensure they maintain part-time/full-time status</li><li>Liaise with corresponding departments to support the admissions team</li><li>Ensure students meet with Faculty Advisors to outline program completion plans</li><li>Track and document all communication with Inquiries, applications and students through Salesforce and Campus Vue</li></ul><ul><li>Contributes to a work environment that encourages knowledge of, respect for, and development of skills to engage with those of other cultures or backgrounds.</li></ul><ul><li>Performs other duties as assigned.</li></ul><p>REQUIRED KNOWLEDGE, SKILLS &amp; ABILITIES:</p><ul><li>Sales knowledge, skill and experience; in addition to person-to-person account management experience</li><li>Consultative approach to answering questions, addressing concerns and assisting with enrollment decisions</li><li>Highly accountable to monthly goals, performance expectations</li><li>Ability to establish rapport and build relationships with prospective students</li><li>Demonstrated ability to multi-task, organize, manage time while meeting and/or exceeding expectations and goals</li><li>Demonstrated ability to work independently and collaborative with little supervision in an fast-paced environment</li></ul><p>PREFERRED KNOWLEDGE, SKILLS &amp; ABILITIES:</p><ul><li>Keep current on CFP, HD and SOE programs information and State licensure requirements</li><li>Understanding of and experience with non-traditional student populations</li><li>Keeps current on credential program information and the schools credentialing requirements&nbsp;</li><li>Excellent written and verbal communication skills; accuracy and attention to detail</li><li>Possess professional interaction, personal networking and constituency building skills; and possess interesting, dynamic, articulate, credible and fluid group presentation skills</li><li>Ability to meet annual inquiry plans as recorded weekly</li><li>Inquiry generation and effective inquiry follow-up capability</li><li>Self-directed and highly motivated, high activity action taking recruiting students</li><li>Executing continuous high volume contact, mapping out efficient travel logistics, coordinating and conducting events, sustaining high levels of diverse activity and multi-tasking under strict deadlines</li><li>Knowledge of the education industry</li><li>Demonstrated, consistent results producer.</li><li>Enrollment, academic advising knowledge/experience</li><li>Ability to guide prospective students through the university admissions process and overcome any obstacles that may arise</li><li>Excellent written and verbal communication required</li><li>Excellent ability to speak in public and conduct presentations for large groups and one on one.</li><li>Possess a positive and enthusiastic attitude to promote a healthy work environment.</li><li>Ability to travel evenings and weekends; possess valid driver’s license</li><li>Ability to work evenings/weekends and have a flexible schedule</li><li>Self-motivated, goal-oriented, results driven</li></ul><p>REQUIRED EDUCATION:</p><ul><li>Bachelor’s degree required with minimum of 1 years' experience in college admissions, recruitment or sales preferred; OR a minimum of 5 years' history in an enrollment/admissions position in nontraditional higher education recruitment;</li></ul><p>PREFERRED EXPERIENCE:</p><ul><li>Minimum 1-2 years’ experience in college admissions, recruitment or student services preferred.</li><li>Experience working with non-traditional students</li><li>Sales Knowledge or Sales Experience</li></ul><p>PHYSICAL REQUIREMENTS (based on a typical week):</p><p>Key:</p><p>C&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; =&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Constant(over 66% of time)</p><p>F&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; =Frequent(34%-66% of time)</p><p>O&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; =&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Occasional(1%-33% of time)</p><ul><li>Lifting/carrying under 10 lbs. – O</li><li>Pushing/pulling under 10 lbs. – O</li><li>Reaching outward – O</li><li>Sitting – C</li><li>Standing – O</li><li>Bending – O</li><li>Walking on normal surfaces – F</li><li>Typing/keyboarding/ten-key – C</li><li>Fine handling/grasping – O</li><li>Repetitive motion (hands) – O</li></ul><p>Compensation &amp; Benefits</p>This opportunity is budgeted at $20.00-21.50 base compensation. Additional compensation factors may impact total compensation. To learn more about our competitive benefits and additional rewards, including generous paid time-off, medical and dental insurance coverage, life and disability insurance, retirement plan with employer contribution, multiple flexible spending accounts, tuition reimbursement, click the link below.<p><a href="https://www.pacificoaks.edu/about/careers-pacific-oaks/" target="_blank">https://www.pacificoaks.edu/about/careers-pacific-oaks/</a></p><p>Pacific Oaks is an Equal Opportunity Employer.</p><p>Pacific Oaks participates in E-Verify and verifies identity and employment eligibility of all persons hired.<br></p><p><i>The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. Pacific Oaks offers equal employment opportunities to all persons without regard to race, color, ethnicity, religion, sex, sexual orientation, national origin, age, marital status, physical or mental disability, parental status, housing status, source of income or military status, in accordance with applicable federal, state and local EEO laws.</i></p>

53 Healthcare / Pharmacy Jobs in California