Hospice and Palliative Care Nurse, Hospice and Palliative Care Program
Remote in California

Mon to Fri, 08:00 AM-4:30 PM
2+ Months Potential to extend depending on the business needs or performance.

Your Role
The Hospice and Palliative Care team has responsibility for policies and oversight of clinical processes for members. The Hospice and Palliative Care Nurse will report to the Sr. Manager, Hospice and Palliative Care. In this role you will be responsible for assisting in the audits of hospice providers and medical records of members enrolled in hospice. You will also be involved with the development and implementation of medical policies, clinical research and data analysis. You will also assist in overseeing clinical operations and ensuring that guidelines for appropriate levels of care are correctly applied.

Your Work

In this role, you will:
• Perform audits of Hospice Providers, using clinical judgement to determine authenticity of services performed
• Monitor department performance metrics to ensure all review documentation is completed, organized and entered in the program data system per established timelines
• Assist leadership with implementation of hospice and palliative care policies and workflows
• Report any instances of noncompliance to leadership along with recommended corrective actions
• Perform clinical research through all available resources to ensure that current and accurate information is being used internally
• Ongoing development of the hospice and palliative care review process including clinical and utilization data analysis
• Assist in documenting any end-to-end process for policy development including communication, roles, department standards, workflows, and data management
• Attend and participate in all meetings related to hospice and palliative care policy development, discussion and operational implementation of pertinent medical policies
• Assist in developing training documents and presentations for new and/or revised hospice and palliative care policies to internal stakeholders
• Work closely with the clinicians in Medical Operations to understand current workflow based on what is considered medically necessary, not medically necessary or investigational

Your Knowledge and Experience
• Requires a bachelor’s degree or equivalent experience
• Requires a current California RN license
• Requires at least 7 years of Health Plan, ASO or IPA/Medical Group Experience specifically servicing Medi-Cal members
• Experience with Hospice operations and clinical guidelines
• Experience in auditing or oversight
• Proficient in program operations and metrics
• Proficient knowledge of NCQA, DHCS and DMHC requirements
• Strong communication and computer navigation skills
• Strong Excel skillset
• Critical thinking skills
• Independent motivation and strong work ethic 
 
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $ 45.00/hr.