DHCS Certified Nurse Reviewer RN

The Job Holder
Pasadena, CA, USA
Jan 15, 2020

Client Name

Kaiser Permanente


Under the heading of the Manager - Regulatory Medi-Cal Certification Programs, RN, performs Department of Health Care Services (DHCS) Facility Site Reviews (FSR), Medical Record Reviews (MRR) and Physical Assessment Reviews (PAR) in consistence with DHCS Medi-Cal Managed Care Division, (MMCD). This includes guaranteeing through Site Reviews and Audits that the consideration conveyance areas where representatives and doctors give care to MMCD individuals meet all prerequisites for affirmation through DHCS. 

Basic Responsibilities: 

  1. This is working from home position, incline toward possibility to live inside the Los Angeles County region and are required to make a trip up to 75% of the opportunity to different Kaiser Permanente Clinics all through Southern California. Travel may incorporate Orange and San Diego regions varying. 
  2. Freely plan and play out the DHCS MMCD Facility Site Review (FSR), Medical Record Review (MRR), and Physical Accessibility Review (PAR) studies as alloted all through Southern California, dominatingly Los Angeles, Kern, San Bernardino, and Riverside districts. 
  3. Guarantee the exhibition of all FSR studies led is as per DHCS - MMCD and Plan Partner necessities. 
  4. Play out all FSR correspondence and is finished as per set up strategy and technique. 
  5. Report all FSR discoveries to suitable suppliers, divisions and Regulatory Medi-Cal Certification Manager. 
  6. Issue restorative activity plans (CAP) when important, report CAP to Regulatory Medi-Cal Certification Manager and guarantee CAPs are shut convenient. 
  7. Guarantee accommodation of FSR/MRR/PARs are submitted to Regulatory Medi-Cal Certification Manager Weekly 
  8. Go to all required FSR preparing, State or potentially Plan Partner, as required to keep up a current degree of Site Reviewer affirmation (CSR, DPT, CMT) 
  9. Keep up California Board of Registered Nursing RN permit and DHCS-MMCD Certified Site Reviewer, Designated Plan Trainer or Certified Site Reviewer affirmation. 
  10. Proficient Competencies: Demonstrates mechanical education in utilizing modernized data frameworks. Gets to, assesses and utilizes information and data from a wide scope of assets. Exhibits powerful utilization of PC based data and practice the board frameworks for choice help, the arrangement of care, nonstop quality improvement, and expert advancement. 
  11. Applies powerful oral and composed relational abilities in associating with individuals from the human services group including basic reasoning, affecting, critical thinking, and explanatory aptitudes. 
  12. Capable in Excel and Word applications. Force Point experience additionally liked.