Virtual Insurance Verification Jobs in Riverside, CA

The Nurse Practitioner provides high quality advanced nursing care in accordance with professional regulatory standards and within the scope of the nurse practitioner license. This role provides multidisciplinary care providing patient evaluations and assessments, patient education, interventions, and documents plan of care. Requests physician consultations and multidisciplinary consults. Recognizes that ethical/legal/medical dilemmas exist in the nursing practice, and confers with the appropriate resources and staff when making ethical decisions. May work as an independent provider and/or under indirect supervision of a supervising physician. May see all and treat a variety of age populations.

Depending on area, may work different hours, weekends and holidays. May require on-call time.

Privileges granted by the Medical Staff Department can include arranging admission and transfer of patients, performing and dictating exams, history and physicals, rounding on assigned patients and writing progress notes with plan of care, and dictating discharge summary. Also may furnish medications (non-narcotic) and durable medical equipment (DME), controlled substances III, IV, V with appropriate licensure/certification, and controlled substances II with appropriate licensure/certification. May order blood products, laboratory tests, radiological, ultrasound, nuclear medicine, and neurological studies, oxygen therapy, respiratory treatment, and pulmonary tests. May perform drain and suture removal. May order and administer medications and IV therapy with the ability to assess and adjust appropriate dosing.

Performs other duties as assigned.

Hoag Compass – Jamboree: In addition to the above the Hoag Compass Nurse Practitioner provides support through a face to face, chat, texting, or video platform. Must be competent in the use of Consumer Health technologies and software, for example, fitness wearables and health software applications.

Hospice: In addition, the Hospice Nurse Practitioner is responsible for providing explanation of benefits to GIP program and home hospice candidates (or their DPOA), and admitting patients to the hospice GIP program. The Hospice NP functions as an integral member of the hospice interdisciplinary team and provides daily visits for hospice care patients and coordinates their plan of care with other designated hospice and hospital staff, and, on an as-needed basis, fulfills the requirements of the "face-to-face encounter" with a Medicare beneficiary enrolled in hospice.

Heart Valve Clinic: In addition to the above, the Heart Valve Clinic Nurse Practitioner may be responsible for providing advanced clinical care to patients with complex heart failure across inpatient and outpatient settings, working closely with cardiologists, surgeons, and the multidisciplinary team.

Risk Adjustment: In addition, the Risk Adjustment Nurse Practitioner is responsible for the execution of guided processes to complete Annual Health Assessments "AHAs" for Hoag Clinic's Medicare patient population. Works with patients with chronic illnesses commonly encountered in the adult and geriatric patient population. Responsible for assessment, diagnosis, education, health promotion, and care coordination for patients with acute and chronic health needs. In addition, must have advanced knowledge of HCC Coding and Documentation, and Quality Measure guidelines.

Qualifications

Education and Experience

• Master's in Nursing (MSN) or DNP required.
• Completion of proctoring by Medical Staff Office.
• Advanced clinical knowledge and skills in the care and management of patients.
• Additional department specific requirements are as follows:
• Breast Care: 3 years' experience in Women's Health or Adult Oncology as a nurse/NP or equivalent. Advanced clinical knowledge in personalized cancer risk assessment. Training or education in genetics, bilingual preferred.
• Cardiac Admin: Experience in adult/geriatric cardiovascular care. Experience in cardiovascular data collection preferred.
• Emergency Dept: Experience in psychiatric/mental health.
• Endoscopy/Surgical Center for Digestive Diseases: Experience in adult/geriatric care, ambulatory, and/or inpatient care preferred.
• Hoag Compass: 3 plus years of clinical nursing experience, preferably in primary care. Experience delivering care through a hybrid, virtual, and in-person model a plus. Knowledge of electronic medical record systems, patient registration, scheduling, and insurance verification process. Must have a passion to be a part of a team dedicated to changing healthcare access & delivery.
• HMG – Primary Care: Experience in Family or Internal Medicine and/or adolescent/adult/geriatric care preferred.
• HMG – Urgent Care: Urgent care/ER experience or 3 years of Family Medicine as a NP preferred. Comfortable working as a single provider and seeing patient of all ages. Proficient in procedures frequently performed in an urgent care setting.
• HOI: Experience in Orthopedics and/or recent adult/geriatric acute care preferred.
• Neuro/Oncology Clinic: Experience as a Nurse/NP in Adult Oncology/Neurology or equivalent education and experience. Bilingual or multilingual and/or clinical trial experience preferred.
• Neuroscience: Minimum of 1+ year recent experience as a NP, preferably in an ambulatory and acute healthcare environment or experience in Neuroscience. 2+ years experience preferred. Bilingual or multilingual preferred. May be asked to participate on the Crisis Response Team, Addiction and Pain Management Service. For C&L Psychiatric, 2 years recent experience as a PMHNP.
• Medical Imaging (Nuclear Medicine, Neuro-Interventional Radiology, etc.): Minimum 2 years of experience performing or assisting in invasive procedures performed with the utilization of advanced imaging.
• Palliative Care: 2 years' advance practice nursing experience, including prescribing experience, in relevant area. Experience in adult/geriatric care preferred. Advanced knowledge and assessment skills in Palliative Care preferred.
• Risk Adjustment: Experience in Family or Internal Medicine and/or Geriatric Care preferred. Bilingual or multilingual preferred
• Heart Valve Clinic:2+ years cardiology or advanced heart failure experience preferred. Experience with advanced therapies (LVAD, transplant, MCS) preferred.

License Required

• Current license in good standing to practice as a Registered Nurse and Nurse Practitioner in California
• Furnishing license issued by the State of California and personal DEA number (For all areas other than Breast Center).
• Endoscopy Clinic: DEA license required within 6 months of position effective date.
• HATC Admin: Psychiatric Mental Health Nurse Practitioner license designated by manager
• Infusion Centers: DEA license required within 90 days of position effective date
• Neurosurgery – Pituitary: NPF – Nurse Practitioner Furnishing

License Preferred

Neurosciences C&L Psychiatric: PMHNP strongly preferred

Certifications Required

• BLS required. National board certification as Nurse Practitioner in area of specialty required (except Outpatient Oncology).
• Additional department specific requirements are as follows:
• Cardiac Administration: ACLS required. DEA: DEA License
• Chemical Dependency - ACLS Required
• Emergency Department: ACLS required.
• Endoscopy/Surgical Center for Digestive Diseases: ACLS required.
• Heart Valve Clinic: ACLS required
• HATC Admin: ACLS required
• HMG – Primary Care: ACLS required.
• HMG – Urgent Care: National Certificate in area of specialty required.
• Hoag Orthopedic Institute: Completion of an ECG course and testing or equivalency required.
• Neuro/Oncology Clinic: ACLS required. ONS certification preferred.
• Neurosurgery – Pituitary: ACLS required
• Neuroscience: ACLS required.
• Nuclear Medicine: ACLS required.
• Pain Management - ACLS Required
• Palliative Care: ACLS required.
• Risk Adjustment: ACLS required.
• Infusion Centers: ACLS required. DEA: DEA License
• Solmar Retreat: BLS – AHA Basic Life Support. Must have Current negative TB test and health screen report or questionnaire clearance by a physician prior to employment. The tuberculosis test shall be conducted under licensed medical supervision not more than 45 working days prior to employment or 5 working days after employment and renewed annually from the date of the last TB test.

Certifications Preferred

Hoag Orthopedic Institute: Orthopedic Nurse Certification preferred.

About Us

Hoag Memorial Hospital Presbyterian is a nonprofit regional health care delivery network in Orange County, California, consisting of three acute-care hospitals with sixteen urgent care centers, eleven health centers and a network of more than1,800 physicians, 100 allied health members, 8,000 employees, and 2,000 volunteers. More