The Utilization Management Nurse Specialist LVN II for the Utilization Review Clinical Department is primarily responsible for the overall coordination for L.A. Care Health Plan Direct Lines of Business under the direction of a Registered Nurse. This position works collaboratively with the health care team to coordinate care and placement for the Skilled Facility admissions. Member’s needs may include physical health, discharge planning, behavioral health, social services and Skilled Care Facility services and supports.

Qualifications

• Associate's Degree
• At least 3-5 years of clinical experience in Utilization Management/Case Management
• HMO managed care experience with prior experience in ambulatory case management, utilization management, disease management or any combination of education/experience.
• Good working knowledge of regulatory requirements/standards of Title 22 and State Regulations. 
• Experience working with the Medi-Cal and Medicare populations.
• Experience in rehabilitation therapies(inpatient or outpatient); knowledge of available community resources; experience in working and referral to community based organizations.
• Previous experience in a health plan and/or Independent Practice or Physician Association (IPA)/Participating Physical Group (PPG) setting developing and performing UM case management/case management a plus.

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.