RN Care Management Specialist - FT - 2088A

Job Description

The Care Management Specialist is primarily responsible for the overall coordination of care and services for LA Care Health Plan members. Responsibilities include, technology implementation and integrity, ensuring regulatory and accreditation compliance, program utilization and outcome reporting. This 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 LA Care diverse membership.

In Collaboration with the Interdiscplinary Care team members, the Care management specialist performs telephonic physical, functional, behavioral and social assessments, develops and maintains a member centered individualized care plan developed using evidence 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 research all potential resources if gaps exist for that member within their service continuum, continuously maintaining an advocacy position.

Qualifications

EDUCATION

Required: Bachelor's Degree in Nursing

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, active, unrestricted California Registered Nurse license

Preferred: Case Management Certification; Public Health Nursing certification; Certified Nurse Practitioner

EXPERIENCE

Required: 3 years of Acute clinical experience care experience, Previous case management experience; Managed care experience; strong clinical skills with a knowledge of complete assessment techniques; knowledge of health and/or patient education and behavioral change techniques; Computer literacy - Proficiency with Microsoft Office (Excel, Word, etc.); Excellent interpersonal and communication skills; Good working knowledge of regulatory; requirements/standards; Adaptability to fast-changing environment; Time management and priority-setting skills; Experience working with Medi-Cal and Medicare population.

Special Instructions

Req. Number: 2088A