Health Homes Nurse Liaison RN II

Job Summary

The Health Homes Nurse Liaison RN II is responsible for the management and oversight activities associated with L.A. Care's Community-Based Care Management Entity (CB-CME) network. The position reports to the Director, Health Homes Program and receives clinical supervision as needed from the Medical Director, Care Management. The position is responsible for providing oversight, feedback, and technical assistance to CB-CMEs to support effective delivery of Health Homes services. The position is responsible for conducting regular meetings with CB-CMEs, reviewing Health Risk Assessments & Health Action Plans, providing guidance on clinical best practices, and assisting with escalation for cases that require additional assistance from L.A. Care. The position works directly with SNI and Care Management staff to inform CB-CME capacity-building and training activities related to Health Homes Program operations.

Duties

Conduct regular monitoring and coaching with CB-CMEs to review aggregate progress and individual HHP member cases. May use telephonic, onsite, or written methods and both group and individual CB-CME activities to monitor performance related to CB-CME clinical and service requirements. Provide guidance on best practices to CB-CMEs.

Conduct regular, random sample review of Health Risk Assessments (HRAs) and Health Action Plans (HAPs) created by CB-CMEs. Identify any gaps in HHP services and provide coaching and feedback to CB-CME to improve.  Identify any issues that require escalation or more frequent monitoring of the CB-CME.

Provide training, education and consultation as necessary to CB-CMEs. Collaborate with other HHP staff on identifying topics and developing materials for CB-CME training and capacity-building. 

Assist CB-CMEs with escalation of HHP member cases that require additional assistance from L.A. Care. Coordinate with internal L.A. Care departments such as Care Management (CM), Utilization Management (UM), Managed Long Term Services and Support (MLTSS), Social Services, Health Education, as well as external providers such as Partificipating Physician Groups (PPGs) and Primary Care Physicians (PCPs). 

Actively identifies and implements efforts to improve the quality, effectiveness and efficiency of Health Homes Program.  Assist co-workers with special projects or work volume as required. Communicates any barriers to supervisors in an efficient and effective manner. 

Perform other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:
Minimum 7 years of previous care management experience to include auditing/oversight/performance management experience.

Skills

Required:
Working knowledge of Medi-Cal or other state sponsored programs.

Excellent verbal and written communicating skills; excellent interpersonal skills.

Proficiency in Microsoft Office MS Office applications.

Ability to solve complex problems/issues and identify creative solutions.

Maintain confidentiality in compliance with all Health Insurance Portability and Accountability Act (HIPAA) requirements.

Ability to solve complex issues and identify creative solutions with external agencies.

Excellent project management skills.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information

Preferred: 
Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance