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clinical research coordinator i

pharmacy program coordinator

Cedars-Sinai Medical Center

<p></p><div><div><div><div><p><b>Job ID</b> 16736</p>
<p><b>Location</b> Los Angeles, California, United States
</p><p><b>Job Category</b> Compliance / Quality
</p><p><b>Date posted</b> 04/28/2026</p></div></div><p></p><div><br>
<div></div>
</div></div><div><h2 class="jobSectionHeader"><b>Job Description</b></h2><p>
When the work you do every single day has a crucial impact on the lives of others, every effort, every detail, and every second matters. This shared culture of passion and dedication pulses through Cedars-Sinai, and it&rsquo;s just one of the many reasons we&rsquo;ve achieved our six-consecutive Magnet designation for nursing excellence. From working with a team of premier healthcare professionals to using state-of-the-art facilities, you&rsquo;ll have everything you need to do something incredible&mdash;for yourself, and for others. Join us, and discover why we are tied #1 in California and ten years in a row on the &quot;Best Hospitals&quot; Honor Roll.</p><p>
This role is a remote position. A staff member who works exclusively from home may be in California or one of the following approved states - Arizona, Nevada, Oregon, Colorado, Texas, Minnesota, Georgia and Florida.</p><p>
Position does require employee to be onsite 1x a month for monthly regulatory inspection of medication storage.</p><p>
The remote Clinical Prior Authorization Pharmacist Specialist at Cedars-Sinai Medical Center will work in collaboration with the Prior Authorization Pharmacy Technician, Drug Use Policy, as well as the authorizing providers to ensure safe, effective, and reasonable use of high cost-drug therapies. Clinical Prior Authorization Pharmacists support timely patient treatment and optimize reimbursement for these medications. The prior authorization staff support clinical prior authorizations for medical benefits, prevent denials, advocate for patients and assist in evaluation of payer (insurance) drug criteria. Additional responsibilities include but are not limited to payor update reviews, claim data analysis, assist with appeal process, review and incorporate payor clinical criteria into medication use guideline. The Prior Authorization Pharmacist also provides supports in navigating and obtaining payer coverage approval to facilitate discharge and/or prevent an admission.</p><p>
The Pharmacist is responsible for clinical pharmacy services, including but not limited to identification of drug-related problems, identification of medication safety issues, review of medication orders for appropriateness and provision of in-services/drug information to the outpatient clinic sites of care and patients. The Clinical Prior Authorization Pharmacist Specialist will also supervise the associated pharmacy technicians.</p><p>
#LI-RD1</p><h2 class="jobSectionHeader"><b>
Qualifications</b></h2><h2 class="jobSectionHeader"><b>
Educational Requirements:</b></h2><ul><li>
Pharm.D. or equivalent degree from an accredited school of pharmacy.</li></ul><h2 class="jobSectionHeader"><b>
Licenses/Certifications:</b></h2><ul><li>
Current pharmacist licensure in the State of California.</li><li>
BLS certification as outlined in the Pharmacist Responsibilities in Cardiopulmonary Resuscitation(C.P.R.)</li></ul><h2 class="jobSectionHeader"><b>
What else are we looking for?</b></h2><ul><li>
Completion of a PGY1 residency or equivalent practice experience. Prior authorization experience is highly preferred.</li><li>
Possesses excellent clinical data base.</li><li>
Possesses experience in Medication Use Evaluation.</li><li>
Possesses excellent verbal and written communication skills.</li><li>
Possesses software skills e.g., Microsoft Office.</li><li>
Comprehensive knowledge of medical terminology as related to drug usage.</li><li>
Comprehensive knowledge of common disease states and pathologies.</li><li>
Ability to comprehend patient medical management plans.</li><li>
Ability to assess and apply current pharmacological and biopharmaceutical principles for the selection and use of drug products in a clinical setting.</li><li>
Ability to extract pertinent information from the patient or other sources and relate it to the patient care plan.</li><li>
Possess the verbal and written communication skills required to fulfill the pharmacist&rsquo;s responsibilities.</li><li>
Ability to teach and serve as preceptor for training programs.</li><li>
Ability to prepare drugs needed for immediate administration.</li><li>
Ability to provide recommendations and monitor the use of drugs.</li><li>
Knowledge of laws, regulations and standards relative to pharmacy practice.</li><li>
Ability to adapt to change.</li><li>
Ability to prioritize workflow.</li><li>
Ability to evaluate medication regimens to meet the therapeutic needs of patients.</li><li>
Ability to learn and adapt to the use of automated information systems in daily practice.</li><li>
Demonstrated competency in techniques of pharmaceutical calculations, compounding and pharmacokinetics.</li><li>
Possess patient-centered communication skills.</li><li>
Possess computer skills necessary to perform job functions.</li><li>
Exceptions to be approved by the Chief Pharmacy Officer or designee.</li></ul>
</div><div><div><div><b>Req ID</b> 16736</div>
</div><div><div><b>Working Title</b> Pharmacy Program Coordinator - Clinical Prior Authorization - Remote</div>
</div><div><div><b>Department</b> Pharmacy Training</div>
</div><div><div><b>Business Entity</b> Cedars-Sinai Medical Center</div>
</div><div><div><b>Job Category</b> Compliance / Quality</div>
</div><div><div><b>Job Specialty</b> Patient Safety</div>
</div><p></p><div><div><b>Overtime Status</b> EXEMPT</div>
</div><div><div><b>Primary Shift</b> Day</div>
</div><div><div><b>Shift Duration</b> 8 hour</div>
</div><div><div><b>Base Pay</b> $77.28 - $123.65</div></div></div></div><p></p>
<br><div><div><h3 class="jobSectionHeader"><b>Diversity and Inclusion at Cedars-Sinai</b></h3>
<div>
We are caretakers and innovators committed to the pursuit of equitable healthcare. But health equity is not possible without representation. Our commitment to diversity goes beyond demographics or checking boxes. Our people must reflect the diverse identities, experiences and geographies of the communities and patients we serve &ndash; because that&rsquo;s what our patients, colleagues and communities deserve <b>Quality Care and Research&mdash;For All, By All</b>.</div>
</div><div><h3 class="jobSectionHeader"><b>Our compensation philosophy</b></h3>
<div>We offer a competitive compensation package for our employees. The base pay range shown generally applies to the greater Los Angeles area and may vary based on work location. Our range takes into account the wide range of factors that are considered in making compensation decisions, including knowledge/skills: relevant experience and training, education/certifications/licensure; and other business and organizational factors. The base pay range does not include any incentive payments that may be applicable to a role. <b>Pay Transparency Non-Discrimination Provision (PDF) </b>.
</div></div><div><h3 class="jobSectionHeader"><b>Cedars-Sinai is an Equal Employment Opportunity employer.</b></h3>
<p>
Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. If you need a reasonable accommodation for any part of the employment process, please contact us by email at <b>Applicant_Accommodation@cshs.org</b> and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.</p>
<p>
Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.</p>
<p>
At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu). For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through April each year) as a condition of employment, and annually thereafter as a condition of continued employment, subject to medical exemption or religious accommodation. For the same reason, you may also be required to receive other vaccines as a condition of employment. Cedars-Sinai reserves the right to make modifications to its required list of vaccines as required by law and/or policy.</p></div></div><div></div>

Pharmacy Program Coordinator

Walgreens

<div><ul><li>Models and delivers a distinctive and delightful customer experience.</li>
<li>Registers sales on assigned cash register, provides customers with courteous, fair, friendly, and efficient checkout service.</li>
<li>In accordance with state and federal regulations, assists the pharmacist, under direct supervision, in the practice of pharmacy. Responsible for using pharmacy systems to obtain patient and drug information and process prescriptions.</li>
</ul><b>Customer Experience</b>
<ul><li>Engages customers and patients by greeting them and offering assistance with products and services. Resolves customer issues and answers questions to ensure a positive customer experience.</li>
<li>Models and shares customer service best practices with all team members to deliver a distinctive and delightful customer experience, including interpersonal habits (e.g., greeting, eye contact, courtesy, etc.) and Walgreens service traits (e.g., offering help proactively, identifying needs, servicing until satisfied, etc.).</li>
</ul><b>Operations</b>
<ul><li>Provides customers with courteous, friendly, fast, and efficient service.</li>
<li>Recommends items for sale to customer and recommends trade-up and/or companion items.</li>
<li>Registers customer purchases on assigned cash register, collects cash and distributes change as requested; processes voids, returns, rain checks, refunds, and exchanges as needed. Takes customer to OTC aisle when possible to assist in locating products.</li>
<li>Keeps counters and shelves clean and well merchandised, takes inventory, and maintains records. Checks in and prices merchandise as required or as directed by store manager or communicated by the shift leader.</li>
<li>Performs duties as assigned by Pharmacy Manager, Staff Pharmacist and Store Manager including utilizing pharmacy systems to enter patient and drug information, ensuring information is entered correctly, filling prescriptions by retrieving, counting and pouring pharmaceutical drugs, verifying medicine is correct, and checking for possible interactions. Assists pharmacists in scheduling and maintaining work flow.</li>
<li>Reports, immediately, prescription errors to pharmacist on duty and adheres to Company policies and procedures in relation to pharmacy errors and the Quality Improvement Program. Reviews and complies with the Walgreen Co. Pharmacy Code of Conduct.</li>
<li>Strictly adheres to the Walgreen Co. policy regarding Good Faith Dispensing during all applicable prescription dispensing activities.</li>
<li>Handles telephone calls that do not require personal attention of the pharmacist, including those to physicians.</li>
<li>Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient manner, and performs other clerical duties, as assigned by the Pharmacy Manager.</li>
<li>Assists and supports Pharmacy Department on inventory management activities, such as, ordering, unpacking, checking and storing shipment of pharmaceuticals. Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages (merchandise billed, but not received), order errors or damaged goods involving Rx drugs.</li>
<li>Ensures compliance with state and local laws regarding regulated products (e.g., alcoholic beverages and tobacco products).</li>
<li>Constructs and maintains displays, including promotional, seasonal, super structures, and sale merchandise. Completes resets and revisions as directed.</li>
<li>Assists with separation of food items (e.g., raw foods from pre-cooked) and product placement as specified by policies/procedures (e.g., raw and frozen meats on bottom shelves). For consumable items, assists in stock rotation, using the first in, first out method and restock outs.</li>
<li>Has working knowledge of store systems and store equipment.</li>
<li>Provides customer service in the photo area, including digital passport photo service, poster print and creative machine, suggestive sell of promotional photo products.</li>
<li>Assumes web pick-up responsibilities (monitors orders in Picture Care Plus, fills orders (pick items), delivers orders to customers as they arrive at store).</li>
<li>Assists with exterior and interior maintenance by ensuring clean, neat, orderly store condition and appearance.</li>
<li>Complies with all company policies and procedures; maintains respectful relationships with coworkers.</li>
<li>Completes special assignments and other tasks as assigned.</li>
</ul><b>Training &amp; Personal Development</b>
<ul><li>Earns and maintains PTCB certification through the designated PTCB training program and/or state required certification/registration.</li>
<li>Attends training and completes PPLs requested by Manager or assigned by corporate and acquires continuing education credits. Maintains knowledge and skill in healthcare and pharmacy, including latest news and developments.</li><br>
</ul><br>
<br>
<b>Basic Qualifications</b>
<br>
<ul><li>Must be fluent in reading, writing, and speaking English. (Except in Puerto Rico)</li>
<li>Requires willingness to work flexible schedule, including evenings and weekend hours.</li><br>
</ul><br>
<br>
<b>Preferred Qualifications</b>
<br>
<ul><li>Prefer six months of experience in a retail environment.</li>
<li>Prefer to have prior work experience with Walgreens.</li>
<li>Prefer good math skills so they can fill prescriptions accurately, including counting, measuring and weighing medications.</li>
<li>Prefer good computer skills.</li>
<li>Prefer the knowledge of store inventory control.</li>
<li>Prefer PTCB certification.</li>
</ul>We will consider employment of qualified applicants with arrest and conviction records.
<br>
<br>
An Equal Opportunity Employer, including disability/veterans.
<br>
<br>
The actual compensation that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. This role will remain open until filled. To review benefits, please click here jobs.walgreens.com/benefits. If you are applying on a job board or unable to click on the link, please copy and paste this URL into your browser jobs.walgreens.com/benefits
<br>
<b>Salary Range:</b> $18.87 - $21 / Hourly</div>
<br><div><h2 class="jobSectionHeader"><b>Benefits</b></h2>
<ul><li><h3 class="jobSectionHeader"><b>Health, dental and vision*</b></h3></li>
<li><h3 class="jobSectionHeader"><b>Prescription coverage</b></h3></li>
<li><h3 class="jobSectionHeader"><b>Retirement Savings Plan (401(k))</b></h3></li>
<li><h3 class="jobSectionHeader"><b>Employee discount</b></h3></li>
<li><h3 class="jobSectionHeader"><b>Work &amp; life resources</b></h3></li>
<li><h3 class="jobSectionHeader"><b>Career development programs</b></h3></li>
</ul><ul><li>with a 30-hour work week</li></ul></div>

Pharmacy Customer Service Associate

CVS Health

<div><p>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.</p><p></p><p><b>
Position Summary</b></p><p></p><p>
Health is everything. At CVS Health, we are committed to increasing patient access to care, lowering costs and improving the quality of care. Millions of times a day, we&rsquo;re helping people on their path to better health&mdash; from advising patients on their prescriptions to helping them manage their chronic and specialty conditions. Because we&rsquo;re present in so many moments, big and small, we have an active, supportive role in shaping the future of health care. Pharmacy Technicians are at the forefront of our purpose as they deliver compassionate care to our millions of patients every day.<br>
<br>
Come join our team of dedicated and caring Pharmacy Technicians who demonstrate our core values of Accountability, Caring, Collaboration,Innovation and Integrity in everything they do in our pharmacies every day. Whether you are new to working in pharmacies or are an experienced Pharmacy Technician, we have a place for you on our team to use your skills and talents to serve and care for our patients and customers.<br>
<br>
The Pharmacy Technician position provides individuals with an opportunity to work in a leading retail pharmacy company and in a role that positively impacts the lives and health of others. You will work in an environment where the highest professional and ethical standards are maintained as well as full compliance with all Federal, State and Local laws and regulations. Pharmacy Technicians take important steps to ensure all medication needs and regulatory compliance standards are met for our patients and they demonstrate ethical conduct and maintain patient confidentiality at all times.<br>
<br>
Success for incumbents in this role includes being able to manage all assigned pharmacy workstations and tasks to support the team&rsquo;s ability to promptly, safely and accurately fill patient prescriptions all while providing caring service that exceeds customer expectations. If you like working in fast-paced environments and demonstrating compassionate, genuine care for patients and customers, this job is for you!<br>
<br>
As a new Pharmacy Technician, you are required to complete an extensive CVS Pharmacy Technician Training Program as well as satisfy all registration, licensing and certification requirements according to your State&rsquo;s Board of Pharmacy guidelines. Your Pharmacy Technician duties will be restricted by your manager at first until you complete all necessary requirements. Once you satisfy all requirements and expand your Pharmacy Technician duties, you have the opportunity to continue to build your clinical, technical and insurance knowledge and expertise by leveraging available tools and training to build your pharmacy career.<br>
<br>
Are you ready to help people on their path to better health? We are ready to have you join our team and help you on your career path to achieve your goals!<br>
<br>
Please note in select markets the collective bargaining agreement rules regarding the Pharmacy Technician would apply.<br>
<br>
DISCLAIMER:<br>
<br>
The above information on this description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.<br>
<br>
Based on the role and location, this position may require you to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless you are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated. Proof of vaccination will be required on your first day of employment or within the first few months in the position, depending on the role and location. If you are considered for a role, more information will be provided during the hiring process.</p><p><b><br>
Required Qualifications</b></p><p></p><ul><li>
Must be at least 16 years of age</li><li>
Licensure requirements vary by state<br>
</li><li>
Attention and Focus<br>
o The ability to concentrate on a task over a period of time without being distracted<br>
</li><li>
Customer Service Orientation<br>
o Actively look for ways to help people, and do so in a friendly manner<br>
o Notice and understand customers&rsquo; reactions, and respond appropriately<br>
</li><li>
Communication Skills<br>
o Use and understand verbal and written communication to interact with customers and colleagues<br>
o Actively listening by giving full attention to what others are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times<br>
</li><li>
Mathematical Reasoning<br>
o The ability to use math to solve a problem, such as calculating day&rsquo;s supply of a prescription<br>
</li><li>
Problem Resolution<br>
o Is able to judge when something is wrong or is likely to go wrong; recognizing there is a problem<br>
o Choosing the best course of action when faced with a complex situation with several available options<br>
<br>
PHYSICAL DEMANDS:</li><li>
Remaining upright on the feet, particularly for sustained periods of time</li><li>
Moving about on foot to accomplish tasks, particularly for moving from one work area to another</li><li>
Picking, pinching, typing or otherwise working primarily with fingers rather than whole hand or arm</li><li>
Extending hand(s) and arm(s) in any direction</li><li>
Bending body downward and forward by bending spine at the waist</li><li>
Stooping to a considerable degree and requiring full use of the lower extremities and back muscles</li><li>
Expressing or exchanging ideas by means of spoken word; those activities where detailed or important spoken instructions must be conveyed accurately</li><li>
Perceiving the nature of sounds at normal speaking levels with or without correction, and having the ability to receive detailed information through oral communication<br>
</li><li>
Visual Acuity:<br>
o The worker is required to have close visual acuity to perform activities such as: transcribing, viewing a computer terminal, reading, visual inspection involving small parts<br>
</li><li>
Occasional lifting of up to 30 lbs; exerting up to 30 lbs of force occasionally and/or up to 10 lbs of force frequently, and/or a negligible amount of force constantly to move objects</li></ul><p><b><br>
Preferred Qualifications</b></p><p></p><ul><li>
Previous experience in a pharmacy, retail, medical, or customer service setting</li><li>
Previous experience as a Pharmacy Technician</li><li>
PTCB National Certification</li></ul><p><b><br>
Education</b></p><p></p><p>
High School diploma or equivalent preferred but not required.</p><p></p><p><b>
Anticipated Weekly Hours</b></p>
24<p></p><p><b>
Time Type</b></p>
Part time<p></p><p><b>
Pay Range</b></p><p>
The typical pay range for this role is:</p><p></p>
$19.46 - $19.46<p></p><p>
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.</p><p><br>
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.</p><p></p><p><b>
Great benefits for great people</b></p><p></p><p>
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.</p><br>
This part‑time position is eligible for a range of benefits and programs that support the physical, emotional, and financial well‑being of colleagues. Depending on hours worked and eligibility, the benefits for this position include dental, vision, wellness resources, employee discounts, access to certain voluntary benefits, and other programs.<p><br>
Additional details about available benefits are provided during the application process and on Benefits Moments.</p><br>
We anticipate the application window for this opening will close on: 07/08/2026<p></p><p>
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</p></div>

Pharmacy Technician

Jubilant Radiopharma

<div></div><div><div><div><h4 class="jobSectionHeader"><b>JOB DESCRIPTION</b></h4></div></div><p></p><div><p>
Jubilant Radiopharma, the fastest growing radiopharmaceutical company in the nation, is seeking a <b>Full Time driver</b>for its Los Angeles location. <b>The hours which include early morning shiftsareon a monthly rotating shift.</b></p><p>
Address:5903 East Slauson Ave<br>
Los Angeles, CA 90040</p><p>
Join our winning team! Work for a company that provides hope to patients who depend on our pharmaceutical delivery of imaging and theragnostic agents. You will drive one of our modern company vehicles to facilities around the {location} area. We employ over 400 drivers nation-wide across our pharmacy network. We are looking for courteous, caring and safe drivers who can make a difference in a patient&rsquo;s life. Jubilant Radiopharma proudly embraces diversity in our workforce.</p><ul>
<li>Medical, dental, and vision benefits effective on the first day of your employment</li>
<li>Company matched retirement plan</li>
<li>Paid time off &ndash; Prorated New hire through three (3) years</li>
<li>Employee Assistance Program</li>
<li>Employee Discounts</li></ul><p>
Job responsibilities include:</p><ul>
<li>Ensure safe and timely delivery of products to customers while complying with instructions and prescribed routines, methods or procedures;</li>
<li>Operate COMPANY vehicle to deliver products to hospitals, clinics, and other facilities as instructed;</li>
<li>Maintain a safe and clean work area and comply with safety procedures and equipment operating rules keeping work area in a clean and orderly condition. 25% of this job is working in the pharmacy area following SOP&rsquo;s for cleaning and disinfecting tools/ work areas.</li></ul><p>
Requirements include:</p><ul>
<li>Driver or runner work experience preferred;</li>
<li>Customer focused; team oriented:</li>
<li>Light, occasional physical effort required to move, lift and deliver containers and boxes up to 65 lbs.</li>
<li>Continuous mental and visual attention required to drive vehicle and deliver products, involving repetitive or diversified work requiring constant alertness or activity.</li>
<li>Ability to operate vehicle and maintain a valid driver&rsquo;s license.</li>
<li>1 Year relevant experience (Preferred)</li></ul><p>
Starting hourly rate $21.00.</p><p>
Candidates whose experience matches what Jubilant Radiopharma is seeking will be contacted directly for an interview. If candidates need assistance in applying for this position, please call 407-455-6700. Candidates must successfully complete pre-employment drug screen and criminal background check. AA/DFWP/EOE &ndash;M/F/Individuals with Disabilities/Protected Veteran.</p><p><br>
Thank you for your interest in joining the Jubilant Radiopharma team!</p></div></div><p></p>

Medical Courier I

L.A. Care Health Plan

<div></div><div><div><div><div><div><div><div><p>Special Investigation Unit Investigator III
</p></div></div></div></div><div><div><div><div><b>Job Category: </b>Administrative, HR, Business Professionals
</div></div></div></div><div><div><div><div><b>Department: </b>Special Investigations Unit
</div></div></div></div><div><div><div><div><b>Location:
</b>Los Angeles, CA, US, 90017
</div></div></div></div><div><div><div><div><b>Position Type: </b>Full Time
</div></div></div></div><div><div><div><div><b>Requisition ID: </b>13060
</div></div></div></div><div><div><div><div><div><b>Salary Range:</b> $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)</div><br>
<div></div>
<div>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation&rsquo;s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br>
<br>
Mission: L.A. Care&rsquo;s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br>
</div><div><div><div><div>Job Summary</div>
</div><div><p>
The Special Investigation Unit Investigator III performs in-depth evaluation of potential fraud &amp; abuse cases and develops complex investigations that involve high dollar amounts, sensitive issues, or that otherwise meet criteria for fraud, waste &amp; abuse. In addition, this position is responsible for building the investigative approach and provide leadership for Investigators through mentoring, on-site audit leadership and hands-on training of investigative techniques.</p><br>
<p></p>
<div>Responsible for in-depth investigations requiring subject matter expertise for suspected provider, pharmacy, employer or member fraud or abuse across all products at L.A. Care Health Plan. Ensures adherence to L.A. Care's policies and procedures for its various product offerings. Conducts investigation-related training. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.</div>
</div></div><div><div><div>
Duties</div>
</div><div><p>
Investigates allegations and complex issues pertaining to potential health care fraud by providers or members. Makes potential fraud &amp; abuse determinations by utilizing a variety of sources including data analytics to detect unusual billing. Proactively seeks out and develops leads received from fraud tips and any variety of sources (e.g., fraud alerts, media) and initiates appropriate action. Writes comprehensive investigatory/fact-finding reports and summaries documenting interviews and findings. Reviews information contained in standard claims processing system files (e.g. claims history, provider files) to determine provider billing patterns and detect potential fraudulent or abusive billing practices or vulnerabilities in Medi-Cal/Medicare policies and initiates appropriate action. This position is a leader at onsite audits as assigned in conjunction with investigation development. Completes investigations after referrals to law enforcement (Department of Health Care Services (DHCS), Centers for Medicare &amp; Medicaid Services (CMS), Department of Justice (DOJ) or local police). Participates at hearings/appeals and can testify as a witness in court proceedings. Initiates the process with L.A. Care&rsquo;s Recovery Services for recoupment of overpaid monies.</p><br>
<p></p>
<p>Submits referrals of suspected fraud cases within mandated period of time as required by DHCS and CMS. Prepares and submits investigative report documenting all phases of an investigation. Compiles and maintains various documentation and other reporting requirements while following all confidentiality and security guidelines. Maintains cases referred to law enforcement and responds to requests for information; pursues applicable administrative actions during investigation/case development.</p><br>
<p></p><div>Participates in industry meetings/trainings and is able to effectively share and gather significant information. Develops and maintains strong working relationships with associates and regulators including DHCS, DOJ the FBI, Local Law Enforcement, Prosecutors, etc. Continually enhances investigative skills and understanding of emerging issues and trends impacting the industry.</div><br>
<div></div><p>Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project&rsquo;s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.</p><br>
<div></div>
<div>Perform other duties as assigned.</div>
</div></div><div><div><div>
Duties Continued</div>
</div></div><div></div><div><div><div>Education Required</div>
</div><div><div>Bachelor's Degree in Criminal Justice or Related Field</div><div>
In lieu of degree, equivalent education and/or experience may be considered.</div></div></div><div><div><div>
Education Preferred</div>
</div><div><div>Master's Degree in Criminal Justice or Related Field</div></div></div><div><div><div>
Experience</div>
</div><div><div><b>
Required:</b></div>
<p>Minimum of 5 years of experience in healthcare fraud investigation/detection and/or healthcare related specialty including but not limited to; Pharmacy, DME, Mental Health, Behavioral Health, Hospice, Home Health, Dental etc.</p>
<p>Experience conducting fact-finding interviews or investigations to gather information and draw conclusions from various accounts and versions of the same event.</p><br>
<p></p>
<p>Experience managing large amounts of data including pivot tables, complex calculations, and ability to perform comparisons across multiple large data sets</p><br>
<p></p>
<p><b>Preferred:
</b></p><div>Diverse experience as subject matter expert (SME) with multiple specialties including: Pharmacy, DME, Mental Health, Behavioral Health, Hospice, Home Health, Dental etc.</div>
</div></div><div><div><div>
Skills</div></div><div><div><br>
<b>Required:</b><br>
Excellent research skills and the ability to support conclusions with documentary evidence.</div><br>
<div></div>
<div>Excellent analytical, problem solving, and resolution skills and the ability to discern the practical application of regulatory and legal requirements.</div><br>
<div></div>
<div>Demonstrated strong organizational skills and the ability to manage multiple demands and priorities.</div><br>
<div></div>
<div>Excellent and effective communication skills, both verbal and written.</div><br>
<div></div>
<div>Proficient computer skills, including computer applications such as MS Word and Excel.</div><br>
<div></div>
<div>Understanding of the vital importance of commitment to excellence and demonstrating a high regard for organizational values.</div><br>
<div></div>
<div>Ability to maintain in-depth working knowledge of fraud investigation techniques and mentor less experienced team members.</div><br>
<div></div>
<div><b>Preferred:
</b></div><div>Proficiency with Access.</div>
</div></div><div><div><div>
Licenses/Certifications Required</div>
</div></div><div></div><div><div><div>Licenses/Certifications Preferred</div>
</div><div><div>Accredited Health Care Fraud Investigator (AHFI)</div><div>
Certified Fraud Examiner (CFE)</div><div>
Certified Professional Coder (CPC) designation by the American Academy of Professional Coders</div></div></div><div><div><div>
Required Training</div>
</div></div><div></div><div><div><div>Physical Requirements</div>
</div><div><div>Light</div></div></div><div><div><div>
Additional Information</div>
</div></div></div><div></div><div><b>
Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.</div><br>
<div></div>
<div><b>L.A. Care offers a wide range of benefits including</b></div>
<ul><li>Paid Time Off (PTO)</li>
<li>Tuition Reimbursement</li>
<li>Retirement Plans</li>
<li>Medical, Dental and Vision</li>
<li>Wellness Program</li>
<li>Volunteer Time Off (VTO)</li></ul><div><br>
</div></div></div></div></div><p><br>
<b>Nearest Major Market: </b>Los Angeles
<br>
<b>Job Segment: </b>Medical Coding, Pharmacy, Behavioral Health, Clinic, Hospice, Healthcare</p></div></div></div><div></div>

Special Investigation Unit Investigator III

Children's Hospital Los Angeles

<div>Location/Org Data : Introduction:
<div>
Join a team that's shaping the future of pediatric care. Children&rsquo;s Hospital Los Angeles is consistently ranked among the top 10 children's hospitals in the nation, delivering world-class care through more than 350 specialized programs and services. Here, world-class experts in medicine, research, and education work together to deliver family-centered care to more than 155,000 patients each year. At CHLA, your work will help build brighter tomorrows for the children and families we serve.</div>
Overview:
<div><b>
Schedule:</b> Monday-Friday, Day Shift</div><div></div><div><b><br>
Purpose Statement/Position Summary:</b> The Clinical Research Coordinator I assists principal investigators or other study team members with research studies and assists with subject recruitment, data collection, scheduling of study-related activities and follow-up with enrolled subjects.<br>
<br>
<b>Minimum Qualifications/Work Experience:</b> 1+ years of experience in clinical trial coordination or computerized databases. 1 year of clinical research (study coordination, data management) or related experience preferred. Contracts, budgets, invoicing, and regulatory experience preferred.<br>
<br>
<b>Education/Licensure/Certifications:</b> High School Diploma, GED, or equivalent required. Bachelor's degree in related scientific field preferred. Certified clinical research associate/coordinator preferred.</div>
Pay Scale Information: CHLA values the contribution each Team Member brings to our organization. Final determination of a successful candidate&rsquo;s starting pay will vary based on a number of factors, including, but not limited to, education and experience within the job or the industry. The pay scale listed for this position is generally for candidates who meet the specified qualifications and requirements listed on this specific job description. Additional pay may be determined for those candidates who exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs. Posting Range: $61,152.00-$100,464.00 Location/Org Data : Closing:
<div>
CHLA is a leader in pediatric and adolescent health, in our community, across the nation, and around the world . As a premier Magnet&reg;-recognized teaching hospital, CHLA offers an environment rooted in learning, collaboration, and compassionate care. . We are home to groundbreaking research, clinical innovation, and a culture that supports personal and professional growth.</div><div>
Since 1932, CHLA has been affiliated with the Keck School of Medicine of the University of Southern California. Through this partnership and our own enduring mission, we remain committed to creating hope and building healthier futures.</div></div>

Clinical Research Coordinator I

University of Southern California

<div><b>Job ID</b> REQ20174951 <b>Category</b> Keck Medicine of USC</div>
<br><div><p>Provides department support for the Continuum of Care Team to facilitate discharge planning and ensure appropriate throughput of patients. Works with Case Managers, Transitional Care Coordinator, and Social Workers to ensure discharge plans are communicated to patients and families during hospitalization and post discharge to ensure continuity and identify clinical barriers. Enables a positive patient experience through the discharge process and connection to resources as needed.</p><p><b>
Essential Duties:</b></p><ul><li>
Partners with members of the Continuum of Care team both case managers and social workers (RN Case Manager, SW Case Manager) in an effort to provide patients and family members a smooth, coordinated patient transition from hospital to home and/or the next level of care.</li><li>
Partners with members of the Care Coordination team to ensure appropriate communication occurs at the point of discharge so that the patients&rsquo; transition is smooth. Provides timely post-acute contact and reinforces post discharge instructions as needed under the direction of the Transitional Care Coordinator.</li><li>
Under the direction and supervision of Transitional Care Coordinator, utilizes multiple referral platforms such as Enso care, e-fax and phone calls etc. to review post-acute referrals. Also reviews discharge instructions and discharge summary to understand patients&rsquo; post-acute plan of care and barriers to follow-up. Provides timely follow-up on all referrals.</li><li>
Under the direction and supervision of the Transitional Care Coordinator, participates in post discharge phone calls to patients. Uses scripts and follows the Cipher Health algorithm for communication with discharged patients.</li><li>
Under the direction and supervision of the Transitional Care Coordinator, communicates frequently and directly with clinic physician staff and other post-acute providers as needed for discharged patients with identified needs.</li><li>
Follows established policies and procedures and workflows regarding post discharge phone calls.</li><li>
Communicates the discharge plan, status of plan to members of the Continuum of Careteam, including allied health care team members. Participates in triad huddles and in the provisioning of assignments of the triad team.</li><li>
Contacts post-acute care facilities as directed by the Continuum of Careteam to assess bed availability, submission of referrals, bed-hold days. Utilizes multiple referral platforms such as faxing, Enso care etc. to facilitate referrals.</li><li>
Coordinates all non-clinical aspects of the discharge planning process as assigned (i.e. durable medical equipment, homeless shelters, non-clinical letters, transportation) reporting any psychosocial needs, barriers or challenges to the appropriate Continuum of Careteam member.</li><li>
Communicates frequently and directly with Continuum of Care team members regarding discharge process needs and priorities. Communicates orders received to the appropriate case manager, works with the Triad team for daily assignments and tasks needing to be completed. Hands off tasks and duties not performed.</li><li>
Participates in departmental meetings, including but not limited to staff meetings, daily huddles, triad huddles, and Continuum of Care team meetings, etc.</li><li>
Utilizes tools (i.e. Medicare.gov website, tablets for patient choice, etc.) as needed to provide patients with skilled nursing facilities and/or information on discharge planning resources within 10 miles or as close to the patient&rsquo;s home as possible.</li><li>
Documents appropriately following departmental standards in the electronic Medical Record.</li><li>
Assists with transfer of patients for lateral and/or acute services.</li><li>
Supports the Continuum of Careteam with arranging transportation using Taxi, Ride Share, ambulance etc.</li><li>
Assists with maintaining and updating current resources (i.e. pamphlets and brochures) for services as needed for post acute care for use by care coordination team.</li><li>
Participates and engages in continuous improvement activities, including huddles and process improvement projects.</li><li>
Follow all departmental standard work and guidelines including the Triad Model of Discharge Planning. Support transitions of care.</li><li>
Develops and maintains positive working relationships with outside post-acute facilities and vendors to promote timely discharge/transfer.</li><li>
Thrives in a fast-paced, multi-faceted team environment, working well with the key stakeholders, meeting tight deadlines, and multitasking a variety of assignments.</li><li>
Strives to support and contribute to the success of the Continuum of Care team&rsquo;s outcome metrics, key performance indicators and /or departmental goals and objectives.</li><li>
Represents the department in a positive and professional manner.</li><li>
Floating between assignments and between Keck and Norris hospitals is required for management of department needs. On-call, weekend coverage and rotation to manage the discharge needs of the patients within the organization is expected.</li><li>
Supports the clinical process for transfer from one level of care to another as medically indicated by the patient&rsquo;s needs. Able to apply clinical knowledge to reference InterQual Discharge Screens and clinical stability for discharge/transition to the next appropriate level of care.</li><li>
Completes clinical authorization process for the discharge medications.</li><li>
Performs other duties as requested/assigned by Director.</li></ul><p><b>
Required Qualifications:</b></p><ul><li>
Req High school or equivalent</li><li>
Req Specialized/technical training Nursing Completion of an accredited vocational nursing program.</li><li>
Req 2 years 2-3 years&rsquo; clinical experience.</li><li>
Req Typing 40-55 WPM. Experience with computer data entry.</li><li>
Req Proficient in Microsoft Office Suite.</li><li>
Req Good organizational skills.</li><li>
Req Strong command of the English language.</li><li>
Req Good customer service skills.</li><li>
Req Ability to multitask and work effectively in a team environment.</li></ul><p><b>
Preferred Qualifications:</b></p><p><b>
Required Licenses/Certifications:
</b></p><ul><li>Req Licensed Vocational Nurse - LVN (CA DCA)</li><li>
Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)</li></ul><br>
The hourly rate range for this position is $28.00 - $47.75. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate&rsquo;s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.
<div><b>Job ID</b> REQ20174951 <b>Posted Date</b> 05/08/2026</div></div><p></p>

Discharge Planning Coordinator, LVN - Case Management - Per Diem 8 Hour Days (Non-Exempt) (Union)

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