Head Nursing Position

Job Description

Job Description

Registered Nurse (RN) — Medical Department Lead / Clinical Operations Manager

Setting: Recuperative Care / Short-Term Post-Hospitalization / Community-Based Care
Service Area: Riverside & San Bernardino Counties
Position: Full-Time

Position Overview

We are seeking an experienced, highly organized, independent Registered Nurse to lead and oversee our Medical Department.

This is not a traditional bedside nursing position.

We are looking for a nurse who can take ownership of clinical operations, manage medical documentation and compliance, coordinate with providers and field LVNs, and ensure our members receive appropriate post-acute medical support throughout their stay.

The ideal candidate is proactive, accountable, comfortable making decisions within their scope, and capable of running day-to-day medical operations without requiring constant direction from executive leadership.

The goal of this position is simple:  own the Medical Department and ensure nothing clinical falls through the cracks.

Core Responsibilities

Medical Department Leadership

• Oversee day-to-day operations of Medical Department.
• Serve as the primary clinical point person for members, LVNs, mobile  physicians, MD providers, and leadership.
• Supervise and coordinate the work of field LVNs serving Riverside and San Bernardino County homes.
• Establish priorities for member visits based on medical needs, new admissions, changes in condition, documentation deadlines, and urgent requests.
• Maintain visibility into the clinical status and outstanding medical needs of members.
• Identify clinical or documentation problems before they become larger operational or authorization issues.
• Escalate emergencies and significant changes in condition appropriately.
• Operate independently while keeping executive leadership informed of significant risks or issues.

Nursing Assessments & Documentation

• Complete and/or oversee required nursing assessments and nursing forms.
• Ensure nursing documentation is accurate, timely, complete, and consistent with available clinical records.
• Review field LVN documentation for completeness and follow up on missing information.
• Maintain organized member clinical records.
• Ensure new admissions receive appropriate nursing review and assessment.
• Track outstanding nursing forms, assessments, encounters, and follow-ups.
• Maintain documentation standards necessary for audits, authorization requests, continued-stay reviews, and payer requirements.

Mobile Physician & Provider Coordination

• Manage the workflow.
• Coordinate timely and efficient turn around for clinical documentation, orders, etc with physicians, NPs, and other medical providers.
• Review provider documentation for completeness and identify missing or conflicting clinical information.
• Ensure required provider notes and supporting documentation are received and properly organized.
• Coordinate follow-up when provider documentation, orders, prescriptions, or clinical clarification is needed.
• Help maintain continuity between provider recommendations and services being delivered at the homes.

Medication Oversight

• Perform and oversee medication reconciliation.
• Identify medication discrepancies and coordinate resolution with providers and pharmacies.
• Support proper medication organization, storage, refill coordination, and member medication compliance within scope.
• Ensure medication-related concerns identified by field LVNs are addressed promptly.
• Coordinate pharmacy and provider communication when medication changes or clarification are required.

Payer & Peer-to-Peer Support

• Participate in Peer-to-Peer (P2P) discussions when clinically appropriate.
• Review the member’s medical history and current clinical condition before P2P discussions.
• Clearly communicate clinical needs, functional limitations, medical risks, and barriers to safe discharge.
• Work with case management and leadership to ensure clinical documentation supports authorization and continued-stay requests.
• Identify documentation weaknesses that could contribute to payer denials and work proactively to correct them.

Member Care Coordination

• Coordinate medical follow-up appointments.
• Assist with DME requests and medical equipment coordination.
• Coordinate home health and other clinical services when ordered.
• Monitor members with chronic conditions requiring additional oversight.
• Coordinate response to abnormal vitals, medication concerns, falls, wounds, glucose-related concerns, respiratory concerns, or changes in condition within appropriate scope.
• Communicate with hospitals, PCPs, specialists, pharmacies, home health agencies, and other providers as necessary.
• Help ensure members transition safely from hospital or facility care into UCFB and ultimately into the community.

Field LVN Management

The Medical Department Lead will oversee  dedicated field LVNs:

Riverside County LVN

• Responsible for routine and immediate-request visits to Riverside-area UCFB homes.

San Bernardino County LVN

• Responsible for routine and immediate-request visits to San Bernardino-area UCFB homes.

The RN will assign priorities, review documentation, identify follow-up needs, and ensure clinical concerns reported by the LVNs are appropriately resolved.

What Success Looks Like

A successful Medical Department Lead should be able to independently answer:

• Which members currently have significant medical concerns?
• Which members require nursing visits today?
• Are all required nursing forms completed?
• Are medications reconciled and discrepancies being addressed?
• Are provider notes and clinical encounters complete?
• Which members have upcoming authorization or P2P concerns?
• What clinical documentation is missing?
• Which members need DME, home health, PCP, specialist, pharmacy, or hospital follow-up?
• Are the Riverside and San Bernardino LVNs completing their assignments?
• Is there anything clinically putting a member or company at risk?

Executive leadership should not have to continuously identify these issues for the Medical Department Lead.

Ideal Candidate

We are seeking someone who is:

• A currently licensed California Registered Nurse in good standing.
• Experienced in post-acute care, recuperative care, home health, skilled nursing, case management, community health, hospital discharge, utilization management, or a related environment.
• Extremely organized.
• Strong with clinical documentation.
• Comfortable reviewing medical records.
• Comfortable communicating with physicians and other healthcare professionals.
• Experienced with medication reconciliation and chronic-condition management.
• Able to manage multiple members across multiple locations.
• Comfortable supervising LVNs.
• Able to recognize when a clinical concern requires escalation.
• Comfortable participating in payer/P2P discussions.
• Proactive rather than reactive.
• Able to work independently without being micromanaged.
• Comfortable building and improving systems as the organization grows.

Strongly Preferred Experience

Experience with any of the following is highly desirable:

• CalAIM Community Supports
• Recuperative Care / Medical Respite
• Short-Term Post-Hospitalization services
• Managed-care organizations
• Molina Healthcare
• Medi-Cal
• Utilization management
• Authorization/reauthorization processes
• Peer-to-Peer reviews
• Home health
• SNF/post-acute care
• Behavioral-health populations
• Substance-use populations
• Housing-insecure populations

Why This Position Is Different

This position is designed for a nurse who wants more responsibility than a traditional staff-nursing role.

We need someone who can  take ownership of a department , build strong clinical systems, manage field nurses, coordinate providers, protect documentation quality, and help ensure members receive safe and appropriate care.

We are not looking for someone who waits to be told what needs to be done.

We are looking for someone who sees what needs to be done and takes responsibility for getting it done.