Top 4 Research nurse Jobs in Ucla Ca

Clinical Policy Nurse RN II
L.A. Care Health Plan —Los Angeles, CA
- $88,854 - $142,166 a year
- Full-time
- Microsoft Word
- Nursing
- Microsoft Excel
- Wellness program
- Health insurance
Registered Nurse - Cardiac Catheterization/Electrophysiology Laboratory
US Veterans Health Administration —Los Angeles, CA
- $116,566 - $210,371 a year
- Weekends as needed
- Hybrid work
- Background check
- Laboratory
- Nursing
- Paid holidays
- Dental insurance
3d
Clinical Policy Clinical Coder RN II
L.A. Care Health Plan —Los Angeles, CA
- $102,183 - $163,492 a year
- Full-time
- Microsoft Word
- Nursing
- Microsoft Excel
- Wellness program
- Health insurance
LVN Case Manager ECM
JWCH Institute —Los Angeles, CA
- $66,967 - $72,116 a year
- Full-time
- Spanish
- Microsoft Excel
- LVN
- Profit sharing
- Mileage reimbursement
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research nurse jobs near ucla ca

Clinical Policy Nurse RN II

L.A. Care Health Plan -
Los Angeles, CA

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Job Details

Full-time
$88,854 - $142,166 a year

Benefits

Wellness program
Health insurance
Dental insurance
Tuition reimbursement
Paid time off
Vision insurance
Volunteer time off
Retirement plan

Qualifications

Microsoft Word
Health policy analysis
Microsoft Excel
Medicare
RN License
Managed care organization experience
CMS
Performance Reporting
Care documentation
Documentation tools
Research report preparation
Health insurance knowledge
Healthcare regulatory compliance research
Content development
Patient care
Medicaid
Document viewing software
Clinical documentation standards
Cross-functional collaboration
Associate's degree
Associate Degree in Nursing
Research findings presentation
Financial data analysis tools
Cross-functional communication
Team building

Full Job Description

Clinical Policy Nurse RN II

Job Category: Clinical

Department: Utilization Management

Location: Los Angeles, CA, US, 90017

Position Type: Full Time

Requisition ID: 13084

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 Clinical Policy Nurse RN II is responsible for analytical research, trending, and assessment based on legislation, regulatory and accreditation requirements that impact claims, Utilization Management (UM) department and healthcare services policies.

Reviews and analyzes clinical financial data to assess the effectiveness of existing and proposed policies to identify opportunities for improvement, cost containment, and quality enhancement. This position plays a key role in translating regulatory impacts into operational strategies and works collaboratively with internal and external stakeholders to ensure clinical policies support safe, effective, and compliant care delivery. Assists in development of policies and programs that improve health outcomes and target Fraud, Waste and Abuse (FWA).

This position works cross functionally with other departments to develop end to end operational strategies of policy content and roll out timeframes. The Clinical Policy Nurse II serves as a liaison to ensure the ongoing maintenance of clinical coding for the authorization matrix.

Duties

Assess federal, state, and local legislation, regulatory guidance, and health care policies to identify potential impacts on clinical practice, reimbursement and organizational operations that impact healthcare services policies.

Review and interpret clinical, utilization, and financial data to identify trends, opportunities for policy improvement and cost-savings.

Research, develop, and evaluate clinical and health policy designed to improve patient outcomes, detect and mitigate Fraud, Waste, and Abuse (FWA), and streamline organizational processes. Monitor the implementation of health programs, clinical initiatives, and community action plans to assess effectiveness, compliance, and impact on patient outcomes.

Collaborate with internal stakeholders to evaluate utilization trends and anomalies and contribute to policy development aimed at improving efficiency and compliance identified during risk assessments.

Prepare analytical reports, summaries, and analyses assessing policy performance, regulatory impact, and communicate insights and recommendations to stakeholders to drive evidence-based policy and impacted outcomes.

Present findings, recommendations, and action plans to key stakeholders.

Participate in work groups related to healthcare services clinical policies and procedures including efforts to improve department processes, as needed.

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 experience in Clinical Nursing.

At least 3 years of experience with Medi-Cal and Medicare in a managed care environment.

Experience in performing and creating clinical documentation.

Experience in regulatory compliance for a health plan.

Preferred:

Experience with active participation in state regulatory audits such as Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Centers for Medicare and Medicaid Services (CMS), and/or National Committee for Quality Assurance (NCQA) audits.

At least 1 year of experience in clinical health services policies with a managed care plan.

Skills

Required:

Demonstrated strong reporting skills by preparing clear, concise reports and presentations that communicate findings and performance.

Working knowledge of clinical policies.

Strong analytical and critical thinking skills with the ability to interpret regulatory requirements and legislation.

Ability to translate regulatory requirements into auditable tools.

Ability to perform independent research on complex medical topics.

Excellent verbal and written communication skills.

Strong problem solving and team building skills.

Ability to work independently with strong self-direction.

Advanced proficiency in Microsoft Word, Excel, and PDF documentation tools.

Ability to work effectively with diverse teams in cross-functional work groups.

Ability to multitask, re-prioritize tasking, and streamline day-to-day operations.

Strong organizational and time-management skills.

Preferred:

Advanced skills in assessing clinical policy deficiencies through literature searching and clinical research analysis based on the best available evidence.

Understanding of the managed care industry and market conditions.

Licenses/Certifications Required

Registered Nurse (RN) - Active, current and unrestricted California License

Licenses/Certifications Preferred

Required Training

Physical Requirements

Light

Additional Information

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)

Nearest Major Market: Los Angeles
Job Segment: Nursing, Registered Nurse, Clinical Research, Medical Research, Medicare, Healthcare

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research nurse jobs in ucla ca

Clinical Policy Nurse RN II

Registered Nurse - Cardiac Catheterization/Electrophysiology Laboratory

Clinical Policy Clinical Coder RN II

LVN Case Manager ECM

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