Care Management Specialist II 12811
Los Angeles, 90017
Manages a specified caseload across the entire continuum of programmatic levels including those within NCQA scope or otherwise Complex/Catastrophic cases, which are those with the severest acuities or care needs and requiring the highest clinical skills and judgement. Management of the caseload assigned by Manager includes: coordinating health care benefits, providing education and facilitating member access to care in a timely and cost-effective manner.
Applies clinical knowledge and experience to evaluate information regarding prospective care management members referred by health risk assessment (HRA), risk stratification, predictive modeling, provider’s utilization review vendors, members, Call Center, claims staff, HHP eligibility or other data sources to determine whether care management intervention is necessary to meet the member's needs.
- Education Required Associate's or Bachelor's Degree in Nursing for Registered Nurses
- Master's Degree in Social Work for Licensed Clinical Social Workers
- Minimum of 3 years of recent care management experience with responsibilities of managing complex acute or chronic conditions in collaboration with members and interdisciplinary care professionals in a hospital, medical group or managed care setting, such as a health insurance environment and/or experience as care manager in home health or hospice environments.
- Licenses/Certifications Required Active & Current Driver's License, with a clean record and Auto Insurance Required
- Registered Nurse (RN);current and unrestricted California License OR Licensed Clinical Social Worker; current and unrestricted California License.
- Licenses/Certifications Preferred Certified Case Manager (CCM)
About the Hospital
As the nation's largest publicly-operated health plan, we have a great responsibility to the communities we serve, and our employees play an essential role in ensuring we meet those needs.
Why Join Us?
Opportunity. Amazing co-workers. A supportive management team. Great compensation and benefits. Camaraderie and a true sense of mission. If you want a career that truly contributes to the good of all, join us as we work towards a healthier L.A.