RN Care Management Specialist - FT - 343 - Los Angeles
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.
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
Required: Current and unrestricted CA RN License
Cert. in Case Management Active & Current Driver's License and Auto Insurance
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.
Req. Number: 343
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