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Managed Long Term Services and Supports Nurse Specialist RN II

Job Category:  Clinical
Department:  Managed Long Term Services and Supports
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  6692

 

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


Applies advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare and social services for L.A. Care members. Utilizes assessments, member-centered care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available HCP, HCBS, and MLTSS resources, optimal member functioning, and cost-effective outcomes.   

 

Collaborate with Preferred Provider Groups, Care Management and Social Workers to facilitate authorization of Care Plan Option (CPO) services and to obtain other services when Multipurpose Senior Services Program (MSSP) is not available. Coordinate the identification, documentation, investigation and resolution of CPO and MSSP related issues and ensures issues are handled in a timely manner.

Duties

Responsible for performing assessments of members referred to MLTSS programs for the identification, evaluation, coordination and management of members' needs, including physical health, behavioral health, social services, and MLTSS.

 

Provides direction to non-clinicians who assist members with accessing services. Conducts additional assessments as necessary, to monitor, evaluate and revise members' care plans to meet members' needs, with the goal of optimizing member health care across the care continuum.  Arranges for all services required while coordinating with the health care team to eliminate duplication of services. 

 

Interfaces with Medical Directors, social workers, and interdisciplinary care team (ICT). Participates in ICT meetings and makes recommendations for MLTSS programs. Responsible for the development of MLTSS action plan and modification of case management care plans. 

 

Establishes relationships with referral sources and community resources, such as external providers, PPGs, APS Healthcare, and MSSP case managers, while maintaining strict member confidentiality and complying with all Health Insurance Portability and Accountability Act (HIPAA) requirements.

 

Facilitates care coordination with internal and external entities to improve member's short and long term goals in collaboration with member, caregivers, family, support systems, and physicians.  A person-centered approach will minimize member confusion, and ensure that the best care is delivered in the most appropriate setting. 

 

Performs clinical review of face to face assessments for CPO services and determines if the request is appropriate for CPO or if those needs can be addressed through other avenues, such as, free community services, covered health plan benefits, and if other needs can be identified and referred to other programs.

 

Documents accurately and comprehensively based on the standards of practice and current organization policies.

 

Performs other duties as assigned. 

Education Required

Associate's Degree in Nursing

Education Preferred

Bachelor's Degree in Nursing

Experience

Required:
At least 5-7 years of clinical nursing experience in direct patient care, such as ambulatory care, home care, or case management.

 

Clinical experience working with individuals with chronic illnesses, comorbidities, and/or disabilities in a case/care management environment. 

 

Experience in home health, health care, discharge planning, behavioral health, community resources, and/or other home and community-based agencies.

 

Skills

Required:
Excellent verbal and written communication skills.

 

Excellent organizational and time-management skills.

 

Proficient in Microsoft Office.

Licenses/Certifications Required

Registered Nurse (RN) - Active, current and unrestricted California License

Licenses/Certifications Preferred

Required Training

Required:
Registered Nurse (RN)

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)

 

At L.A. Care, we value our team members’ safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.


Nearest Major Market: Los Angeles

Job Segment: Nursing, Medical, Patient Care, Social Services, Home Care, Healthcare, Service

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