One element that distinguishes Clinicas del Camino Real, Inc. from the rest is the compassion with which we deliver our services to the general and underserved population in our community. We are proud to have a family of professional and caring individuals who together comprise such a significant entity in the county of Ventura. Ever since our first health center opened its doors over forty years ago, we have continued to grow, improve and expand our services. It certainly would not be possible to accomplish this without the dedication, commitment and ownership that our workforce takes over this prestigious health care organization. If you are someone who wants to work for an organization that makes a difference and have a desire to make an impact on the wellbeing of our local community through your work, we encourage you to apply to become part of our team!
For the Provider Job Listing, please visit Provider Opportunities page.
The following job openings are currently available:
Administrative Assistants
Administration, Compliance
Camarillo
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
Under the supervision of the either the Chief Medical Officer or Compliance Officer, the Administrative Assistant will perform a variety of office and administrative functions.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
Receives and screens requests of persons wishing appointments with management; schedules and maintains calendar of appointments; screens callers, both in person and by telephone to determine the nature of question; handles routine inquiries independently; types a wide variety of internal/external correspondence, reports, proposals, etc.; attends regularly scheduled monthly meetings, prepares agenda and corresponding minutes; composes/drafts routing correspondence as required; develops and maintains administrative files, assists as requested in the preparation of departmental projects, procedures and the implementation thereof; opens and routes incoming mail and email; delivers and picks up mail on assigned times of the day. May handle projects or coordinate projects and maintain reports for routine reporting; tracks expenses and prepares reports regarding such expenses. Performs other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.
EDUCATION, EXPERIENCE AND QUALIFICATIONS
High school graduate. Ability to type accurately at the rate of 65 w.p.m. Computer proficient including thorough knowledge of Microsoft Office Suite including Word, Power Point, Excel and Outlook. Ability to draft professional correspondence, excellent spelling, grammar and punctuation. .Bilingual in English and Spanish preferred.
Levels I & II: Two years of increasingly responsible administrative experience.
Levels III & IV: Five years of increasingly responsible administrative experience.
DISTINGUISHING CHARACTERISTICS
This class functions as a key assistant to a member of management handling confidential and sensitive matters of an administrative nature. Successful functioning is dependent upon good rapport and close working relationship with department heads.
PHYSICAL DEMANDS
Work is performed in a professional setting. Working extended hours may be required as needed. Extended periods of sitting and or standing, telephone work and/or computer work, as well as interactions with other staff members. Ability to lift and transport files; less than 20 pounds. The noise level in the work environment is usually moderate.
EDUCATION, EXPERIENCE AND QUALIFICATIONS
Must have a high school diploma, or equivalent and one year of general clerical experience. Previous experience working in a Human Resources environment is desirable. Proficient in MS Office Word and Excel; experience with Power Point and Publisher is desirable. Working knowledge of general office equipment such as fax, copier, scanner, etc. Ability to type 45 wpm. Must have a strong sense for accuracy and detail. Bilingual English/Spanish is desirable.
Assistant Manager
Administration, Medical
Oxnard
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
The Assistant Manager provides support to the Health Center Manager (HCM) and assists with the oversight of the health center during the absence of the HCM. The Assistant Manager works under the supervision of and reports to the Health Center Manager. Interacts with a multi-cultural population of diverse socioeconomic backgrounds, ages and levels of education. The Assistant Manager is responsible for performing the following duties: Helps plan, direct, organize and implement office procedures for efficient day-to day operations. Assists the HCM with the supervision of the health center and the completion of duties such as, but not limited to, monthly health center reports, keeping inventory of supplies and monthly requisitioning of office supplies. Works with Health Center Manager to analyze and monitor health center operations such as patient flow issues, reviewing appointment scheduling, bank deposits, and billing functions. Orients and trains staff on items such as data collection procedures, telephone techniques, scheduling, filing and items unique to the health center. Serves as liaison between the health center and the billing department; reviews daily charges, ensures accurate daily deposits and corrections and assist with CHDP billing. Front desk scheduling; reviews and inputs Providers’ monthly schedules into health center calendar. Assists the front office staff as requested by the HCM Resolves and responds to patient and staff complaints. Monitors staff and bring concerns and suggestions to supervisor. Follows and enforces health center policies and procedures. Handles personnel issues and issues disciplinary action.
Associate’s Degree (AA or AS) is required; Bachelor’s Degree (BA or BS) is preferred. Formal coursework in the above mentioned areas is desirable, e.g. business communication, computer, ICD-9/CPT coding, etc. Must be enrolled or willing to enroll, in formal education in preparation for a future career as a Health Center Manager. Two years of experience working front desk or medical reception preferred; including experience with medical billing, scheduling systems, electronic health records, and medical recordkeeping systems. Must have the ability to supervise and lead staff. Proficiency with use of computers and basic programs is required. Must be able to communicate professionally and effectively in writing and verbally; accurate spelling and grammar. Strong public relations skills. Ability to work in a fast-paced environment and proactively analyze and resolve problems. Bilingual English/Spanish is required; ability to speak, read and write. Knowledge of Medi-Cal and insurance guidelines is desirable. Must have reliable transportation.
Business Intelligence Developer
Business Intelligence and Data Analytics
Camarillo
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
*Please note we are a H1 cap-exempt non-profit organization.
JOB OBJECTIVE
As a member of Data Management Group, the developer will provide the expertise in SQL Server BI Development and work with various data repositories. The developer will be working to develop full stack BI solutions which include implementing of data warehouse, ETL process, data analytics, predictive analysis/trends/patterns, data quality, data governance, interactive visualization, and dynamic reporting. The developer is responsible for leading the development of reporting and analytics solutions for Clinicas’s electronic health record (EHR) system by gathering business needs, documenting requirements, identifying appropriate data sources, and developing reports and dashboards.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
Responsibilities:
The Data Warehouse/BI Developer II is responsible to perform all of, but not limited to, the following duties:
- Develops reports, self-service/interactive dashboards, and analytics packages using business intelligence suite of tools such as Tableau, SSAS, SSRS, SSIS, SSDT
- Calculates clinical metrics using healthcare data from various sources
- Extracts, integrates and processes data to support reporting of provider’s clinical performance, risks, outcomes, and population’s health
- Designs and automates data preparation and reporting programs
- Validates the integrity and accuracy of data
- Participates in project planning, report formats and statistical methodologies
- Investigates and evaluates alternative solutions to meet business needs
- Develops data models, architects and builds scalable/high availability data warehouse environments
- Supports the EMR, EPM, claim, and finance data warehouse
- Acts as an informed and thought partner with business users to analyze data to find answers to complex problems
- Acts as a liaison with end-users to collaborate on short and long term reporting requirements
- Determines project requirements for reporting activities and prepare project plans
- Translates requirements into repository and design; document all design specifications
- Assists in defining best practices and implementation standards for the data warehouse and across business intelligence and reporting delivery tools
- Independently and/or collaboratively develops solutions that are high performance
- Provides technical and administrative support of complex, enterprise-wide analytics systems to ensure data integrity and proper system functioning
- Adheres to and promotes best practices and standards work for all recurring activities.
- Mentors less experienced team members and business users on analytics principles and best practices
- Stays current on relevant industry developments – payment reform, regulations, quality measurement programs such as UDS, HEDIS, and Meaningful Use, performance improvement
Qualifications:
- 3+ years working experience in technical design of data analytics model such as SQL
- 3+ years working experience in developing ETL process and SQL programming skills
- 3+ years working experience in data warehouse environment performing implementation, integration and maintenance of online analytics platform.
- Proven hands-on technical experience with Microsoft Business Intelligence tools such as SSAS/SSIS/SSRS/SSDT and other visualization tools such as Tableau, QlikView, and power BI
- Understanding of database structures, theories, principles, and practices
- Understanding of ETL and data warehouse principles
- Working knowledge in T-SQL creating complex stored procedures and views
- Ability to translate business questions and requirements into reports, views, and BI query objects
- Experience in gathering, documenting, prioritize and tracking requirements
- Proven experience in standardizing process, setting up, supporting, and troubleshooting production systems
- An ability to be a self-motivated, high performance contributor
- Able to effectively work with ambiguity and incomplete information
- Ability to work with a minimal amount of direction while being pro-active in keeping their management informed of project related issues.
- Able to work well with people from all level within organization. Ability to respectfully question ideas and share a point of view with others in support of the business requirements and needs
- Ability to work well under pressure and adapt to changes in priority
- An excellent team player and willing to assist and train other team members to accomplish common goal
- Consistently demonstrate forward thinking.Strong aspiration to learn new technologies
- Possess strong interpersonal and written/verbal skills
- Consistently demonstrate excellent analytical, mathematical and problem solving skills
Additional Considerations:
- Working knowledge of various BI and visualization tools is a plus (Tableau, MicroStrategy, WebFocus, DataStage, Informatica etc.)
- Other programing language (.NET, C#, PowerShell, XML, Python) a plus
- Knowledgeable in predictive analytics (using SAS, R, or SPSS) a plus
Required education:
- A bachelor's degree in Computer Science or closely related field is required
Job Posting created: March 27, 2020.
Dental Back Office
Dental
Camarillo, Fillmore, Moorpark, Newbury Park, Ocean View, Oxnard, Simi Valley - Madera, Simi Valley - East, Ventura
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
Looking for Dental Assistant or Registered Dental Assistant
The Dental Assistant provides support and assistance to our Dentists in providing quality care to our patients. Utilizes knowledge of dental instruments, equipment, and materials. Mixes amalgam and prepares dental accessories for patient visits. Communicates effectively with patients of all ages; provides information and instructions, as well as ease and comfort during appointments. Documents patient visit information utilizing electronic dental records system.
Must have a Dental Assistant certificate. Knowledge of and experience with common dental instruments, equipment, materials, names of the teeth and various surfaces of the crown of the tooth. Will excercise knowledge of principles and methods of sterilization, prophylaxis and dental hygiene. Ability to communicate effectively at a level required for successful job performance. Proficiency with use of computers and MS Word. Bilingual English/Spanish required.
Health Education Outreach Specialists
Health Education
Simi Valley - East, Ventura
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
Under the general supervision of the Outreach Coordinator, Health Center Manager, and oversight of the Director of Health Education and Prevention Programs, the Health Educator Outreach Specialist performs a variety of registration and financial screening functions with the objective of determining eligibility for medical care coverage under the terms of various private and public health care and financial services assistance programs. This position will be primarily entail evening and weekend work out in the community. The Enrollment Specialist is responsible for performing the following duties: • Researches and verifies patient eligibility for different programs and insurance coverage • Registers and interviews patients to obtain accurate and complete demographic and financial information. • Informs patients about the availability of governmental funded and discount programs. • Properly completes enrollment applications through electronic and manual systems. • Provides case management services for individuals and families on public and private health insurance programs. • Provides excellent customer service to patients, vendors and employees. • Must have reliable transportation to be used during working hours for off-site appointments and outreach activities.
- High school diploma or GED Certificate required.
- Must have at minimum two years’ clerical experience.
- Must be bilingual, English/Spanish.
- Must become a Certified Application Counselor under Covered California.
- Experience in a medical setting providing health education to patients is preferred.
- Must possess excellent verbal and written communication skills, strong grammar and spelling with a high degree of accuracy.
- Proficiency with use of computers is required, as well as a proficient level of typing.
- Must be flexible with work schedule and be available to work weekends and evenings.
- Must have reliable transportation.
- Must have and maintain a valid driver’s license.
Health Educator
Health Education, Medical
Newbury Park
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
The Health Educator I will be under the general direction of the Health Education Coordinator designing, developing, and implementing Health Education programs and materials for the community clinic. Responsible for developing and implementing a marketing program to promote the organization’s services. Compiles and prepares monthly and quarterly reports to various funding programs. Assists in the in-house training of staff updating education programs and teaching skills. Assists in the in-house training of staff updating education programs and teaching skills.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
Researches plans, develops and implements health education programs using existing staff and other community resources; assists in the development of pamphlets, flyers, publicity, and other education materials for community clinic patients; provides feedback to Health Education Coordinator for planning of patient programs to meet organization’s goals and objectives; develops and implements a marketing program to increase awareness of organization’s services; serves as advisor and assists program staff in developing pre-testing, and utilizing patient health education materials connected with specific programs; participates in recruiting and training outreach staff; other duties as assigned by the Health Education Coordinator.
Health Educator I: Bachelor’s Degree in Health Education and one year experience in areas defined. Health Educator II: Bachelor’s Degree and two years experience as a Health Educator or a Masters Degree from an accredited school in the public health field and one year experience in coordinating and supervising health education staff. Must be bi-lingual English/Spanish.
KNOWLEDGE AND ABILITIES
Knowledge and planning and developing health education programs; general health guidelines; research methodology; marketing techniques and knowledge of education programs for prenatal/postnatal high risk patients and infant care. Ability to conduct need assessment of rural communities; function effectively as a health care team member; interpret goals and objectives; identify and network with community resources of rural Ventura County; participate in developing health education policy and procedures; collaborate with Federal, State, County and community organizations concerning the need for quality patient health education programs and resources.
Healthcare Greeter
Medical
Ventura County
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
Under the supervision of the Health Center Manager, the Healthcare Greeter (Greeter) will welcome and screen patients, employees and visitors at entrances to their assigned health center. They will provide direction and general information to individuals entering the building.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
The Greeter will be responsible for performing some or all of the following duties:
- Stationed outside of the health center, the Greeter will provide a positive first impression to patients, employees, and visitors by displaying excellent customer service
- Interact in a professional manner and work collaboratively with Clinicas’ staff and patients
- Follow approved script asking individuals entering the facility questions to protect against COVID-19 exposure. The screening process will also include checking temperatures
- Must be able to wear Personal Protective Equipment (PPE) at times when required.
- Performs other duties as assigned including participation in all safety programs, which may include assignment to an emergency response team
EDUCATION, EXPERIENCE AND QUALIFICATIONS
- High school diploma or equivalent required.
- Must have one year of clerical and/or customer service experience, preferably in a medical, dental, optometry or mental health office.
- Medical Assistant Certification preferred.
- Bilingual English/Spanish required. Must communicate professionally and effectively.
- Ability and desire to provide excellent customer service required.
- Must have reliable transportation, as may be required to rotate to other Health Centers as needed.
Human Resources Tech. (Temporary)
Human Resources
Camarillo
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
The Human Resources Technician (HR Tech) puts into practice knowledge of human resources principles and procedures and state and federal employment law in the day-to-day execution of recruitment, benefit administration, employee relations and personnel record processing and management.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
Recruitment:
Responsible for the recruitment and staffing of line-level positions of the organization. Manages employment requisitions, creates job postings, screens applicants, administers pre-employment testing and coordinates interviews with management and lead staff. Inputs applicants into applicant tracking log. Extends employment offers and generates offer letters. Manages pre-employment process; works with Training Coordinator and managers to schedule new hire orientation and training. Processes new hires and internal transfers, creating employee files in HRIS system. Works with/builds relationships with schools and community organizations to source qualified candidates.
Benefit Administration:
Processes benefit enrollments and changes. Sends communication regarding health insurance and retirement plans, maintains third party benefit administrator database up-to-date, works with HR Director on annual open enrollment. Administers leaves of absence practicing knowledge of state and federal laws. Responds to disability and unemployment claims. Coordinates and takes minutes for Insurance and Pension Plan meetings. Processes 403b plan loans and distributions. Processes employee terminations and notifies all relevant parties. Responds to employment verification requests. Creates and processes personnel action forms.
Other:
Answers questions related to personnel policies and procedures; acts as a liaison for employees and management. Prepares reports, assists with the coordination of employee relations functions. Attends and takes minutes for staff and social committee meetings. Performs other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.
EDUCATION, EXPERIENCE AND QUALIFICATIONS
High school diploma or equivalent. Two years’ experience in a human resources environment. Knowledge of state and federal employment law. Experience with administrative and clerical procedures. Strong writing skills; attention to detail and accuracy. Ability to prioritize work, multi-task and meet deadlines. Proficient with MS Office; Word, Excel, Publisher, Outlook. Certification in Human Resources preferred. Spanish required.
Junior Accountant
Finance
Ventura
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
This position is under the supervision of the controller with delegated responsibilities for specific accounting functions with minimal supervision.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
Review of all accounts payable invoices that have been vouched including general ledger account code, invoice dates, back up and approval signatures, purchase orders, and all audit requirements. Reviews purchase orders, maintenance and entry of general ledger charts of accounts. Assist with closing of accounts payable month end and general ledger month end. File all finance reports in good order. Assist with maintenance and control of weekly cash statues reports.
Prepares monthly journal entries for submittal to controller for review and approval include depreciation, short and long term abilities, accounts payable accrual, payroll accruals, grants and contract accruals, and corporate allocation. Assist with preparation of schedules and spreadsheet to reconcile balance sheet accounts. Prepares bank reconcilements, reviews payroll and final report for General Ledger month end, year end, and monthly financial statement.
Invoice contracts on monthly basis including: Farmworkers contract, Rural Health, United way, and other state/local contracts as needed and submit to management for review approval. Prepares quarterly reports for Farmworker and Rural Health Contracts and submit to management for review and approval. Provide weekly report on status of al contracts. Update contract files with all correspondence, funds received and date of invoice.
Prepares monthly journal entries for submittal to controller for review and approval to include: Patient fees receivable, patient revenue accrual, patient fees adjustments, cash short/over and accounts receivables grants/contracts. Assists with preparation of schedules and spreadsheet to reconcile accounts receivable patient fees to general ledger. Supervises preparation of all. Accounts receivable or patient fees reports in Health Pro. Prepares daily cash receipts journal. Coordinate preparation of finance 3R Reports.
Minimum of 12 units Junior College level Business courses to include Accounting I and Accounting II and Business Math. At least one year of supervisory experience and patient accounting work required. Thorough knowledge of billing system, and reports system required. Excellent oral and written communication skills. Demonstrate excellent bookkeeping, grammar, and organizational skills; Comprehend, analyze, and solve problems with a minimum of supervision; adhere to and enforce company policies and procedures.
Minimum of one year experience in the following: Bookkeeping, working with filling systems, operating office machines, 10 key, computers, spreadsheets, calculators, typewriters, and copying machines.
Lead Licensed Vocational Nurse
Medical
Camarillo, Ventura
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
Provide nursing care to clinic patients; prepare patients physically and psychologically for treatment examinations, and scheduling diagnostic studies; teach patients to care for their particular needs; responsible for recognizing and interpreting symptoms and reporting condition of patients to the attending physician; responsible for keeping inventory of stock medicines available and making drug and medical supply orders bimonthly or as needed; administer treatments and medication under physician’ orders; responsible for preparing in-house monthly reports as well as immunization report; other duties might be assigned. Provide supervision of appropriate personnel, coordinate patient flow activities and assist with peer review of patient records in their quality of care system.
Completion of an approved course in vocational nursing practice and techniques in an accredited vocational school of nursing. Possession of a valid license as a Vocational Nurse issued by the State of California. Must have phlebotomy skills and able to administer immunizations. IV"s and blood work certification preferred. Valid CPR. Must be Bilingual in English and Spanish. Must have the ability to supervise and lead staff.
Licensed Vocational Nurse (Temporary)
Medical
Oxnard, Ventura
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
• Provide nursing care to clinic patients • Prepare patients physically and psychologically for treatment examinations, and scheduling diagnostic studies • Teach patients to care for their particular needs • Responsible for recognizing and interpreting symptoms and reporting condition of patients to the attending physician • Responsible for keeping inventory of stock medicines available and making drug and medical supply orders bimonthly or as needed • Administer treatments and medication under physician’ orders • Responsible for preparing in-house monthly reports as well as immunization report • Provide supervision of appropriate personnel, coordinate patient flow activities and assist with peer review of patient records in their quality of care system.
• Completion of an approved course in vocational nursing practice and techniques in an accredited vocational school of nursing. • Possession of a valid license as a Vocational Nurse issued by the State of California. • Must have phlebotomy skills and able to administer immunizations. Valid CPR. • Bilingual in English and Spanish is required.
Medical Assistant
Medical
Camarillo, Oxnard, Simi Valley - Madera
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
The Medical Assistant I, II, III (MA) performs clinical and administrative duties in support of medical Providers. Interprets Providers’ orders in terms understandable to patients of varied educational and cultural backgrounds. Interacts with a multi-cultural population of diverse socioeconomic backgrounds and ages. Reports to the Health Center Manager and works under the direct supervision of medical professional staff, Lead Nurse, Lead LVN or Lead Medical Assistant
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
The Medical Assistant is responsible for performing the following duties:
- Interviews patients to obtain medical information and measures their vital signs.
- Escorts patients to exam rooms and prepares for the medical provider.
- Documents patients’ medical history, vital statistics and information such as test results in the electronic health records (EHR) system.
- Collects blood, tissue or other laboratory specimens as requested by medical provider and prepares them for testing.
- Prepares and administers medications as directed by medical provider.
- Translates and explains treatment procedures, medications, diets and medical provider’s instructions to patients.
- Performs blood draws, administers immunizations and injections.
- Prepares treatment rooms for patient examinations, keeping the rooms neat, clean and fully stocked.
- Cleans and sterilizes instruments and disposes of any contaminated supplies.
- Changes dressings on wounds.
- Contacts medical facilities or departments to schedule patients’ tests and/or admissions (on as-needed basis).
- Performs general office duties such as answering phones and completing forms when necessary.
- Takes inventory and orders medical, lab and office supplies and equipment.
- Maintains logs for recall purposes.
- Performs routine laboratory tests and performs daily testing controls.
- Operates electrocardiogram (EKG), and other equipment to administer routine diagnostic tests.
- Adheres to and follows universal precautions.
- Adheres to and follows established nursing policies, procedures and practices.
- Rotates to other Health Centers as needed.
- Interacts in a professional manner and works collaboratively with Clinicas’ staff and patients.
- Provides excellent customer service to patients, vendors and employees.
- May assist patients with mental illness, substance abuse problems and or/emotional disturbance.
- Due to the nature of the job, may work with or be exposed to information or material of a sexual nature.
- Performs other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.
Must have received formal training and be certified as a Medical Assistant from an accredited school. Formal training and certification may be substituted with 1-2 years of work experience. Must have completed phlebotomy coursework, be able to draw blood and administer immunizations and injections. Phlebotomy certificate is desirable. Current CPR certification is required. Proficiency with use of computers and programs is required. Bilingual in English and Spanish is required. Must have the ability to establish effective relationships with patients and fellow staff; be a team player, self-motivated and detail oriented. Must have reliable transportation, as may be required to rotate to other Health Centers as needed.
Operations Manager
Administration, Operations
Camarillo
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
The Operations Manager reports to the Chief Operations Officer and will be responsible for overseeing the day-to-day management and operation of satellite clinic(s). The Operations Manager will implement the policies and procedures of the organization and work towards enhancing the development of clinic practices. Select, train, and supervise Health Center managers and employees. Assist in budget development and act as a liaison with local funding sources. Provide public relations representation at community functions and assist in the development and maintaining of corporate goals.
Bachelor’s degree, preferably in Business or Public Administration with at least two years of supervisory and management experience. Must have a thorough knowledge of business administration; supervisory, staffing and interviewing techniques and the ability to communicate effectively, both orally and in writing. Experience working with community organizations is desirable. Bilingual English/Spanish is highly desirable.
Optometric Technician
Medical, Optometry
Simi Valley - Madera, Ventura
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
The Optometry Technician supports and provides assistance to the Optometrist. The OT works under the supervision of the Optometrist and reports to the Health Center Manager. The OT performs pre-testing for patient and assists the Optometrist with examinations. Provides education to patients related to their frames and lens options in terms understandable to patients of varied educational and cultural backgrounds. Works with multi-cultural population of diverse socioeconomic backgrounds and ages. Under the direct supervision of the Optometrist, the OT may perform the following duties: Reviews patient history in Electronic Health Records system and updates medications, family history, personal medical and ocular history, tobacco use, etc. Prepares patient for examination. explains the examination process and administers tests to determine the visual capabilities of the patient. Documents notes during an examination.
High school diploma or equivalent is required. Certificate from approved Optometric Technician program or a minimum of one year of experience as a Patient Services Representative in the Optometry department in lieu of formal education/training. Proficiency with the use of computers and basic programs is required. Bilingual English/Spanish is required. Must be a team player, self-motivated and detail oriented. Must have reliable transportation, as may be required to rotate to other Health Centers as needed.
Patient Services Representative
Medical
Camarillo, Fillmore, La Colonia, Newbury Park, Ocean View, Oxnard, Simi Valley - Madera, Simi Valley - East
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
The Patient Services Representative (PSR) works under the supervision of the Health Center Manager. The PSR is the first point of contact for our patients and some of the duties include: • Greeting patients upon arrival and assisting them through the registration process. • Receives payments. • Completes patient’s intake forms and determines eligibility for patients’ ability to pay or their qualification in assistance programs. • Schedules and confirms appointments and works closely with the back-office to ensure an efficient and pleasant visit for our patients.
• Must have a high school diploma or equivalent. • One year of experience working as a front desk receptionist in a medical setting. • Experience working with electronic health records and knowledge of Medi-Cal and insurance billing is highly desirable. • Must be bi-lingual English/Spanish. • The ideal candidate will embody strong customer service and have a sincere desire to provide the utmost professional service and care to our diverse patient population.
Pharmacy Technician
Pharmacy
Ventura
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
The Pharmacy Technician (PT) provides technical, clerical and transportation support for the pharmacy. The Pharmacy Technician works under the direct supervision of the Pharmacy Manager or Staff Pharmacists and reports to the Health Center Manager. Works with a multi-cultural population of diverse socioeconomic backgrounds, ages and levels of education.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
- Preparation, distribution and delivery of medications under the supervision of a licensed pharmacist.
- Updates patient files utilizing Electronic Health Records.
- Inventory management including ordering, stocking, and handling of expired drugs.
- Determines patients’ eligibility and ability to pay.
- Adheres to front desk policies and procedures.
- Receives and post payment with correct payer code to patients’ account.
- Interacts in a professional manner and works collaboratively Clinicas’ staff and patients.
- Provides excellent customer service to patients, vendors and employees.
- May assist patients with mental illness, substance abuse problems and or/emotional disturbance.
- May be required to safely handle hazardous substances.
- Perform other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.
High school graduate or equivalent is required; graduate from a Certified Pharmacy Technician School preferred. Must be certified as a pharmacy technician in the state of California. Proficiency with use of computers and basic programs is required. Must be able to communicate professionally and effectively in writing and verbally; accurate spelling and grammar. In addition, have the desire and ability to provide excellent customer service. Ability to work in a fast-paced environment. Must have good manual dexterity and visual and auditory acuity. Bilingual English/Spanish is required. Must have a valid driver’s license.
Program Manager
Business Intelligence and Data Analytics
Camarillo
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
Under the general supervision of the Chief Business Development Officer, the Program Manager is responsible for the overall direction, coordination, implementation, execution, control and completion of varying Business Development projects ensuring consistency with company strategy, commitments and goals. The Program Manager will manage multiple projects ensuring key objectives and project scopes are met. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery.
ESSENTIAL FUNCTIONS AND RESPONSIBLITIES
The Program Manager will be responsible for the following:
- Lead the planning and implementation of projects that are delegated or assigned by the CBDO.
- Manage multiple, ongoing Business Development project implementations to include the definition of project scope, goals and deliverables.
- Define project tasks and resource requirements.
- Develop and maintain detailed project plan to include milestones, tasks, and target/actual dates of completion.
- Assemble and coordinate project staff. Schedule and conduct project meetings to include logistics, agendas, and meeting minutes.
- Plan and schedule project timelines and revise as appropriate to meet changing needs and requirements.
- Track project deliverables using appropriate tools. Prepare and submit project status reports to management and all stakeholders.
- Provide direction and support to project team.
- Implement project changes and interventions to achieve project goals.
- Conduct project evaluations and assessment of results. Facilitate post implementation review meetings.
- Research new programs, standards, regulations and other information.
- Perform other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.
- Previous experience in project management with proven ability to achieve results.
- Bachelor’s degree in related field.
- Strong communication skills both verbally and in writing.
- Flexible team player with the ability to work in a changing environment.
- Must be able to set and prioritize goals and objectives; excellent time management and organizational skills.
- Ability to work in a fast-paced environment and proactively analyze and resolve problems.
- Must be analytical, strategic and diplomatic.
Quality Improvement Manager
Administration, Medical
Camarillo
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
Under the supervision of the Chief Medical Officer, the Quality Improvement Manager will be responsible to oversee and direct a quality improvement program. This will include analyzing data, fulfilling documentation and reporting requirements. In addition, the QI Manager will develop educational and informational materials, promoting health issues and providing internal and external customer support. The QI Manager will develop and maintain a system for outcomes measurement and reporting to determine whether the organization is achieving its quality goals.
ESSENTIAL FUNCTIONS AND RESPONSIBLITIES
The QI Manager will oversee and monitor the development and implementation of the quality improvement program, in collaboration with the Chief Medical Officer, Chief Operations Officer, Compliance Officer and other staff. The QI Manager will:
- Establish performance improvement targets for quality, service, and efficiency.
- Implement systems to ensure that services conform to regulatory requirements, contractual obligations, and Clinicas policy.
- Design and conduct surveys to assess the achievements of Clinicas and provide feedback to the program.
- Work with Operations and Compliance to conduct quality control audits, ensuring that processes and documentation are compliant with required standards and, implement follow up actions.
- Investigate, monitor, document and report on quality of care and service.
- Recommend changes for quality improvement in clinical Policies and Procedures and Protocols based on updated findings and information.
- Assure that improvement activities are documented and reported within the organization to engage staff in continuous quality improvement.
- Assess quality improvement training needs; plans and implements training for support staff
- Performs other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.
EDUCATION, EXPERIENCE AND QUALIFICATIONS
- Bachelor’s degree in a related field required; Masters preferred.
- Knowledge of QI processes, strategic planning and health services research, design and implementation.
- Minimum three years of clinical work experience in a health care setting including experience managing a quality improvement program.
- Proven ability to achieve results.
- Ability to communicate clearly, both verbally and in writing, with a diverse group of staff. Strong analytical reasoning and ability to interpret and evaluate complex information.
Referral Coordinator
Referral Center
Camarillo
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
Duties:
The Referral Coordinator is essential in obtaining medically appropriate services inside and outside of Clinicas del Camino Real, Inc. Patient needs, including referral to a Specialist, are identified by the Clinicas practitioner and processes through an established referral system. The Referral Coordinator is responsible for expediting the administrative requirements for the patient referrals for Clinicas Health Centers, ensuring that appropriate referrals are made to participating providers within the patients’ health plan, obtaining appointments for Specialist visits, and notifying the patient/member of the appointment. The Referral Coordinator acts as a resource regarding referrals and insurance plans guidelines. Work situations require an ability to interpret medical guidelines, benefits, policies, and procedures in support of their objective to expedite the referral process. Interacts with a multi-cultural population of diverse socioeconomic backgrounds, levels of education and ages.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
- Knowledgeable about the regulations of various payer sources including, but not limited to: Self Pay, Private Insurance, Medi-Cal, Medicare, Medi-Cal & Insurance Managed Care/HMO, Children’s Health and Disability Prevention (CHDP), Healthy Families, Family PACT, and California Children’s Services (CCS). Knowledgeable about the regulations regarding these various payer sources.
- Manages member/patient and provider inquiries regarding referral status, the authorization process and other issues in a courteous and professional manner.
- Data entry of authorization into Electronic Health Records and /or Utilization Review system, ensuring that all referrals are tracked through to a completed visit and a report is received.
- Collaborates with Providers, Health Center Nurses/Medical Assistants, and UM Nurses to obtain additional medical information and notifies UM Nurse of potentially urgent requests.
- Processes all referral requests according to Clinicas’ policies and procedures.
- Verifies member eligibility via insurance carrier and/or Medi-Cal web portal
- Participates in the introduction and implementation of new procedures.
- Makes recommendations regarding changes, improvements, or enhancements to appropriate staff.
- Assists with training and orienting new employees, as assigned.
- Coordinates and assists with obtaining surgery appointments and re-scheduling missed appointments as needed.
- Notifies patients of authorization status, as needed.
- Distributes denial letters to appropriate recipients.
- Attends meetings as assigned.
- Provides excellent customer service to patients, vendors and employees.
- May assist patients with mental illness, substance abuse problems and or/emotional disturbance.
- Due to the nature of the job, may work with or be exposed to information or material of a sexual nature.
- Performs other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.
Requirements:
- High school diploma or GED required; AS degree and/or Medical Assistant Certificate or Medical Billing Certificate preferred.
- Cognitive Skills (Language, Math and Reasoning Ability): High reasoning, high language skills including medical terminology, critical thinking and critical problem solving skills required. Bilingual English/Spanish speaking and writing is required.
- Ability to work in a team environment is required.
- Excellent organizational skills are required.
- Prefer 2 years’ work experience in a medical environment (IPA or HMO preferred), with pre-authorizations and reimbursement.
- Familiar with regulations pertaining to various payer sources.
- Computer Skills: Ability to effectively use Word, Excel, access specific sites on the internet, document within electronic health records and/or authorization system with minimal typing/spelling errors, send e-faxes and email.
- Ability to work with a diverse group of people; handle multiple issues that are time sensitive and to ask appropriate questions.
- Must have reliable transportation to work.
Risk Adjustment Coder
Billing, Finance
Ventura
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
Under general supervision, performs a prospective data mining of chart reviews, analyzes and deciphers clinical .linguistics and medical terminologies in assigning appropriate ICD-10 CM codes, performs a retrospective review, reviews clinical documentation data validation in compliance with Centers for Medicare and Medicaid Services (CMS), Office of Inspector General (OIG), The Joint Commission, and other regulatory government agencies. Review data validations prior to claim submission. Identify trends where clinical documentation improvement areas and areas of opportunities. Provides provider education. Assess and recommend provider performance report cards and training to support efforts to optimize efficiencies and continuous process improvements.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
The Risk Adjustment Coder is responsible for the following:
- Comply with organization’s policies and capable of following directions.
- Prioritize tasks, collaborative work environment.
- Performs an ongoing prospective and retrospective chart reviews.
- Analyzes and deciphers clinical linguistics and medical terminologies to assign appropriate ICD-10 CM does.
- Perform chart audits.
- Identify trends in area of clinical documentation inconsistency, insufficiency and discrepancy.
- Build a trustful rapport with providers.
- Effectively communicate clarifications with providers through task query.
- Provider education on clinical documentation improvement efforts.
- Attention to details impacts accuracy in data validation and quality data analysis.
- Development of hierarchical condition category (HCC) tools and resource materials utilizing scientific evidenced-base medicine.
- Compliance with CMS, OIG, The Joint Commission, and other government regulations and guidelines
- Audits daily encounters to ensure clinical documentations are clear, consistent, concise and completed supported with the monitoring, evaluate, assessment and treatment (M.E.A.T.) or treatment, assessment, monitoring or medicate, plan, evaluate, and referral (T.A.M.P.E.R.™) components and data validation prior to claim submission.
- Track HCC data validation.
- Collaborate with multidisciplinary teams.
- Quantitative analysis data-driven by HCC ICD-10 CM and HCC category count.
- Quality analysis data-driven by HCC validation statuses where areas of improvements and opportunities can be identified.
- Ad Hoc Review.
- Streamlining workflow processes and collaboration with multidisciplinary teams.
- Other duties and tasks as assigned to identify continuous process improvement workflows.
Will perform other duties as assigned, including participation in all safety programs which may include assignment to an emergency team.
- CPC, CRC (AAPC) or RHIT, RHIA, CCS (AHIMA) credentials required. Must maintain current credentials.
- Minimum education: High School Diploma or equivalent. BS/BA preferred.
- 2+ years of experience in Risk Adjustment required.
- Knowledge of medical terminology, anatomy and physiological, pathophysiological and pharmacological concepts.
- Knowledge of ICD-10 coding conventions.
- Comprehensive understanding of EHR contents.
- Experience using software programs, Proficient in using MS Excel, PowerPoint and Word.
- Experience in CMS Risk Adjustment Processing System (RAPS) and Risk Adjustment Data Validation (RADV) audits.
- Familiar with Medicare Advantage Plans.
- Analytics and problem-solving.
- Apply critical thinking, utilize statistical functions, appropriate process improvement methodologies.
- Excellent interpersonal skills and communicate professional amongst multidisciplinary teams.
Risk Manager
Compliance
Camarillo
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
Under the general supervision of the Compliance Officer, the Risk Manager will be responsible for the management of a comprehensive health and safety risk management program. The Risk Manager will identify and manage potential risks and liabilities within the organization and develop appropriate procedures and processes to help mitigate those risks.
ESSENTIAL FUNCTIONS AND RESPONSIBLITIES
The Risk Manager will be responsible for the following:
- Establish appropriate structures and processes in relation to risk reporting, incident management, and health and safety within Clinicas.
- Coordinate the development and review of relevant/required risk and incident management policies, procedures and guidelines.
- In conjunction with appropriate staff, assist in identification of potential risk through risk assessment, analysis of accidents/incidents and near miss incidents, periodic safety inspections and/or audits.
- Educate and train staff about potential risks.
- Develop and support systems and processes for incident management including communication and escalation of serious incidents (internally and to external agencies as applicable).
- Make recommendations to reduce, prevent or eliminate risks identified.
- Maintain a risk audit database and liaise with department heads in relation to issues arising
- Keep up to date with health & safety legislation and guidelines.
- Work with legal counsel in situations of filed claims (as applicable).
- Collect and analyze data to identify problems or vulnerabilities in Clinicas procedures.
- Perform other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.
- Bachelor’s degree in healthcare administration, nursing, or a related field.
- Previous experience in healthcare risk management.
- Strong knowledge of local, state, and federal regulations.
- Proven ability to achieve results.
Scheduling Clerk
Call Center
Camarillo
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
The Scheduling Clerk provides telephone assistance to all of Clinicas patients. This individual works under the supervision of the Office Manager. Works with a multi-cultural population of diverse socioeconomic backgrounds, ages and levels of education.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
The Scheduling Clerk is responsible for performing the following duties:
- Receives inbound telephone calls and provides exceptional customer service.
- Schedules patients’ appointments.
- Determines patients’ eligibility and ensures guidelines and frequency limitations are followed.
- Adheres to call center policies and procedures (adherence, production, quality, and etc.).
- Makes necessary updates to patient information (demographics, insurance information, and etc.) utilizing Electronic Practice Management (EPM).
- Documents telephone conversation in patient’s electronic medical record.
- Communicates with health center staff, including Providers utilizing Electronic Health Record (EHR) tasking system.
- Analyzes the situation and completes research to ensure no rework or follow-up is required.
- Interacts in a professional manner and works collaboratively Clinicas’ staff and patients.
- Performs other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.
EDUCATION, EXPERIENCE AND QUALIFICATIONS
High school diploma or equivalent required. Must have one year of customer service experience; demonstrated ability to listen effectively, use probing skills to obtain relevant information and establish rapport quickly. Call center experience preferred in an automated customer service environment. Proficiency with use of computers and programs is required. The individual must be able to work with multiple programs and type in system while taking information by phone. Communicate professionally and effectively in writing and verbally; accurate spelling and grammar. In addition, have the ability to work in a fast-paced environment and proactively analyze and resolve problems. Bilingual English/Spanish is required.
UM Coordinator
Quality Assurance and Utilization Management
Camarillo
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
Under the general supervision of the UM/QI Director, the UM Coordinator is responsible for processing phone, fax, and electronic authorization requests for medical services from physicians and hospitals (providers) in an efficient, accurate and customer-focused manner. This position will also assist healthcare providers in ensuring compliance as established by program guidelines.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
Effectively handles authorization requests and inquiry phone calls from providers, balancing excellent customer service with efficiency and established turn-around times. Follows appropriate procedures for checking member eligibility, authorization history, and the status of provider participation within the contracted network. Based on the information provided by the provider and gathered from computer systems, determines the appropriate handling of each request. Utilizing accepted protocol, determines authorization requirements based on the type of service requested, the location of the service, and the provider specifics. Inputs review data into systems with minimal errors. Based on authorization rules and urgency, either approves the authorization request, or sends the nurse for review. Communicates authorization specifics to providers and members either verbally through phone calls or written through fax or mailed letters. Interprets a variety of instructions furnished in written and oral forms. Assists in preparing and submitting projects, reports or assignments as needed to meet department initiatives and/or objectives. Assumes responsibility for professional development of self and assists with training other staff members to contribute to their professional development. Attend meetings as assigned. Meet with staff at various health centers as assigned.
Performs other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.
EXPERIENCE AND EDUCATION REQUIREMENTS
- High school diploma or general education degree (GED) required.
- UM or CM certification preferred.
- Medical Assistant Certificate or LVN/RN/LSW preferred.
- Excellent verbal and written communication skills.Bilingual/Spanish preferred.
- Minimum one year related customer service, administrative or related experience required; or an equivalent combination of education, training and experience.Managed care experience preferred.
- Strong analytical and problem solving skills preferred.
- Strong organizational skills and attention to detail.
- Demonstrates excellent interpersonal skills.
Ability to navigate and master proprietary software programs, proficient in MS Office, basic computer and keyboarding skills.
Utilization Management Nurse
Quality Assurance and Utilization Management
Camarillo
This is an excellent opportunity to work for an organization that truly makes a difference in the community. Clinicas Del Camino Real, Inc. offers a highly competitive salary; excellent benefit package including full medical, dental, vision, life and disability insurance; generous holiday, vacation and sick leave.
Under the general supervision of the Quality and Utilization Management Director, the Utilization Management Nurse performs case review and first level determination approvals for inpatient, outpatient, and ancillary services requests. Reviews include benefit determination, medical appropriateness, and medical necessity determination requiring clinical judgment, critical-thinking skills, and detailed knowledge of departmental procedures and clinical guidelines.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
The UM Nurse’s responsibilities include, but are not limited to:
- Conduct clinical review for service requests for medical appropriateness and medical necessity using considerable clinical judgment, independent analysis, critical-thinking skills, and detailed knowledge of medical policies, clinical guidelines, and benefit plans.
- Review, triage, and prioritize authorization requests to meet required turn-around times.
- Expedite access to appropriate care for members with urgent or immediate needs using the expedited review process.
- Research member issues and assess member needs.
- Acquire appropriate clinical records, clinical guidelines, policies, EOC and benefit policy. Accurately applies coding guidelines.
- Develop determination recommendations and present cases to Medical Director (or designee) for potential denial determinations or when Medical Director input is needed.
- Interact with the providers or members as appropriate to communicate determination outcomes in compliance with state, federal and accreditation requirements.
- Develop and/or review appropriate documentation and correspondence reflecting determination. Ensure documentation is accurate, complete and conforms to established regulatory standards.
- Document all activities as per unit practice including entry into automated systems. Recognizes potential quality of care concerns and refers as appropriate.
- Make appropriate referrals to California Children’s Services (CCS) and Tri-Counties Regional Center (TCRC).
- Identify and refer members who may benefit from disease management or case management and make appropriate referrals.
- Manages out of area cases/requests based on current policy and refers them to the primary insurer as appropriate.
- Attend meetings or meet with staff at various health centers as assigned.
Perform other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.
EDUCATION, EXPERIENCE AND QUALIFICATIONS
- Graduate of an accredited nursing program required (e.g. ASN, ADN, BSN, MSN). Bachelor's degree preferred.
- Active, valid, & unrestricted State of California Registered Nurse license is required.
- Minimum three years clinical experience is required.Minimum one year managed care experience.
- Bilingual (English/Spanish) speaking and writing preferred.
- Understanding of federal and state regulations/requirements and/or JCAHO or NCQA criteria.
- Strong analytical and problem solving skills preferred.
- Excellent verbal and written communications skills. .
- A team player who builds effective working relationships but also has ability to work independently.
- Experience using standardized clinical guidelines/criteria (e.g. Apollo Managed Care, Milliman, InterQual Medi-Cal Criteria).
- Strong organizational skills.
- Able to operate PC-based software programs including proficiency in MS Word.