Medicare Care Management Specialist, RN

Job Category:  Clinical
Department:  Medicare Medical Management (642)
Location: 

Los Angeles HQ, California, US

Position Type:  Full Time
Requisition ID:  357

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’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’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.

DUTIES
The Care Management Specialist, RN is primarily responsible for the overall coordination of the Direct Lines of Business programs for L.A. Care Health Plan members. Responsibilities include program development, technology implementation and integrity, ensuring regulatory and accreditation compliance, program utilization and outcome reporting. The position is also responsible for assuring all functions are operating in accordance with the organization's mission, values and strategic goals; are focused on continuous improvement and provided in a manner that is responsive and culturally sensitive to the needs of L.A. Care's diverse membership.

In collaboration with the Primary Care Provider (PCP) and other treatment professionals, performs telephonic physical, functional and psycho-social assessments, assesses readiness to change, develops and maintains a member/family specific individualized care plan developed using evidenced based guidelines, approved clinical practice guidelines or protocols to determine variance from expected outcomes, linking member/family to resources within and outside the health care system and community, and researches all potential resources if gaps exist for that member within their service continuum, continuously maintaining an advocacy position.

The Care Management Specialist, RN may also provide back-up care management support for the other direct lines of business and CCS members as needed                      

QUALIFICATIONS & REQUIREMENTS:

EDUCATION:
Required:
Associate's Degree or Bachelor's Degree in RN

FOREIGN LANGUAGE
Preferred:
Bilingual in one of LA Care Health Plan’s threshold languages:  
English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese, Korean

LICENSES/CERTIFICATIONS
Required:
Current and unrestricted CA RN License

Cert. in Case Management
Active & Current Driver's License and Auto Insurance

EXPERIENCE:
Required:
At least 5 years of clinical experience as an RN with at least 3 years in a managed care/ health plan or medical group environment.
Previous experience in Case management, utilization management/ ambulatory case management or disease management.
Experience working with the Medi-Cal and Medicare populations.

Preferred:
Experience in rehabilitation therapies (inpatient or outpatient); experience in working and referral to community based organizations

L.A. Care offer a wide range of benefits including

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program


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