MLTSS HCBS Specialist

Job Category:  Administrative, HR, Business Professionals
Department:  Utilization Management
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  3864

 

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.

Job Summary

Under the direct supervision of the MLTSS MSSP/CPO/IHSS Manager, the MLTSS HCBS Specialist will be responsible for organizing and prioritizing multiple projects within the MLTSS Department.  Collaborate with all units of the MLTSS Department to review outcomes and then develop process improvements, recommendations and changes. Analyze, prepare reports and distribute reports/outcomes, including error trends, to the MLTSS Department management for follow-up and conduct follow up reviews of corrective action. Conduct periodic targeted audits and oversight of various components of the MSSP, CPO, IHSS, HRA F2F, and Complex Social Services (CSS) programs, in order to evaluate compliance with policies and procedures and MLTSS standards.

Duties

Provides day-to-day oversight of MLTSS reporting activities of MSSP, CPO, IHSS, CSS, and the HRA F2F conducted by the MSSP providers, in order to evaluate compliance with policies and procedures and MLTSS standards.Creates and the reporting tools by collaborating with the reporting data team, Care Management and Social Services to ensure that timely communication feedback, completion and submission  are established and met. Creates a monthly MSSP Document Report to ensure MSSP providers are submitting care plans, initial assessments, reassessments, LOC, psychosocial assessments for LAC to review for care coordination and identify gaps in services. Creates weekly report spreadsheets for Social Services and Plan Partners. Contributes to the creation of internal workflows and desktops procedures to establish standardized guidelines for audits and other internal processes.

Establishes relationships with referral sources and community resources, such as external providers, PPGs, Plan Partners and MSSP providers, while maintaining strict member confidentiality and complying with all HIPAA requirements. Initiate and facilitates coordination of care with internal and external entities to improve member’s short and long term goals in collaboration with member, caregivers, family support systems and physician’s office.

Reviews and generates the MSSP monthly member progress reports, and requisite reports to document LA Care’s adherence to State regulations and procedures. Generates MSSP Weekly Reports of members who have been placed on the waitlist, enrolled, terminated, ineligible referrals, transition to another site, and members who filed for grievances and appeals. Creates monthly MSSP Referral Report spreadsheet of members referred to MSSP. Cross references a Master Weekly Report with the MSSP Referral Report to determine if the providers are processing the referrals and whether or not the referred members have been placed on the waitlist or have been enrolled. Ensures that referrals are being processed by the providers in a timely manner. 

Responsible for oversight and payment process of HRA F2F, CSS, and CPO. Reconciles payments with invoices for accuracy and timeliness and provides a monthly summary report. Generates monthly MSSP invoices from  MSSP providers. Verifies monthly members eligibility, run queries and process invoices for payment. Prepares monthly MSSP Master invoice summary report. Creates a monthly “Reconciliation” Report of the members invoiced by the MSSP sites. Creates a monthly report based off the MSSP invoices of members assigned to Plan Partners which is distributed to the Plan Partners.

Perform other duties as assigned.

 

 

 

Education

High School Diploma/GED

Associate's Degree or Bachelor's Degree

Experience

Required:
With High School Diploma/GED: 4-5 years of proven experience with reporting tools, software and other applications in a health care or managed care environment and demonstrated experience working with seniors and people with disabilities, low economic status populations, or diverse communities, in settings such as community-based organizations.

Preferred: 
With Associate's Degree: 3-4 years of proven experience with reporting tools, software and other applications in a health care or managed care environment and demonstrated experience working with seniors and people with disabilities, low economic status populations, or diverse communities, in settings such as community-based organizations.

With Bachelor's Degree: 2 years of proven experience with reporting tools, software and other applications in a health care or managed care environment and demonstrated experience working with seniors and people with disabilities, low economic status populations, or diverse communities, in settings such as community-based organizations.

Required:
Strong analytical, conflict resolution and persuasion skills.

Design reports for performance and data quality.

Creative and with strong attention to details.

Strong knowledge of MLTSS programs.

Knowledge of managed care and an understanding of Medicare and Medi-Cal programs

Strong customer service.

Excellent verbal and written communication skills.

Strong technical skills, including ability to merge data from various sources.

Proficient with Microsoft Office including Outlook, Word and Excel, Access, CITRIX.

Strong analytical, conflict resolution and persuasion skills.

 

Professional Licenses

Professional Certifications


 

Required Training

Additional Information

 

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

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


Nearest Major Market: Los Angeles

Job Segment: Medical, Social Services, Medicare, Healthcare, Service