Pediatric Nurse, Lead

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. This is a remote position, however, must reside in California.

What You Will Be Doing:

Responsible for achieving overall clinical performance goals through day-to-day direction of the designated clinical care team, coordinating operational processes, monitoring performance to achieve consistent process standards and metrics through quality assessments, training, and improvement tactics, and in compliance with regulatory and NCAA accreditation standards.

Our Vision:

Continuously improve the health of our community.

Our Mission:

We provide healthcare value and advance wellness through community partnerships.

Essential Functions:

In a partnership with the Inpatient Supervisor, leads the Pediatric team and provides day to day oversight of team functions to meet all regulatory guidelines and company initiatives for CCS and pediatric cases.

· Works in collaboration with the supervisor to identify and implement consistent work processes to achieve compliance standards and continuous operational readiness in accordance with NCQA accreditation and State regulations.

· Monitors daily workflow including incoming referrals, case load and acuity management to meet production standards and to achieve compliance standards according to regulatory guidelines and company initiatives for CCS and Pediatric cases.

· Independently oversees and advises the correct application of methodology and outcomes monitoring and reporting for members eligible for the CCS program.

· Provides subject matter expertise to staff.

· Utilizes clinical knowledge to apply evidence- based practice guidelines and criteria.

· Conducts and records both focused and standard QI audits in collaboration with Supervisor. Provides feedback for team members and the management team.

· Tracks and trends performance, identifies root causes, and reports and recommends improvement opportunities to management, based on audit results.

· Coaches, trains, and conducts follow up for team performance improvement.

· Collaboration with the Superior to identify, design and deliver training modules to promote improved performance and/or implement new regulatory guidelines pertinent to pediatric programs.

· Carries caseload, as assigned by the Supervisor; and provides coverage as needed.

· Acts as subject matter expert and participated in the training of new clinical personnel.

· Maintains the Unit’s Training Manual and Desktop Procedures (Job Aids)

· Regular and consistent attendance.

What You Bring:

Knowledge, Skills, Abilities and Competencies

Required

· Produces work that is accurate and complete.

· Produces the appropriate amount of work.

· Actively learns through experimentation when tackling new problems, using both successes and failures to learn.

· Rebounds from setbacks and adversity when facing difficult situations.

· Knows the most effective and efficient process to get things done, with a focus on continuous improvement.

· Self-motivated with effective critical thinking skills.

· Strong oral and written communication skills.

· Strong customer service skills.

· Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.

· Strong ethics and high level of personal and professional integrity.

· Computer literate and highly proficient in using MS office programs.

· Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.

· Strong ethics and high level of personal and professional integrity.

· Ability to direct clearly and in an organized pattern

· Ability to promote learning and self-empowerment in associates.

· Computer literate and highly proficient in using MS office program

What You Have:

Education and Experience

Required

· Associate degree in nursing.

Preferred

· Baccalaureate Degree in Nursing.

· Minimum two years acute clinical experience; two years experiencing in utilization management in health plan, medical group or IPA setting is preferred.

· Utilization Management experience with MCG Criteria.

Licenses, Certifications

Required

· Current and valid, unrestricted California state RN nursing license.

· Valid Driver Licenses with no driving restrictions.

Preferred

· Current Certified Case Manager (CCM) Preferred.

What You Will Get:

HPSJ Perks:

• Competitive salary
• Robust and affordable health/dental/vision with choices in providers
• Generous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
• CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
• Two flexible spending accounts (FSAs)
• Employer-Paid Term Life and AD&D Insurance
• Employer-Paid Disability Insurance
• Employer-Paid Life Assistance Program
• Health Advocacy
• Supplemental medical, legal, identity theft protection
• Access to exclusive discount mall
• Education and training reimbursement in addition to employer-paid elective learning courses.
• A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
• A shorter commute ­– if you’re commuting from the Central Valley to the Bay Area.
• Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.

We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.

HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics, or is associated with anyone who has or is perceived to have these characteristics.

Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.