LTSS RN Case Manager

Medical Case Manager-LTSSHealthCare Support is actively seeking a Medical Case Manager-LTSS to fill an opening with a Managed Care Organization in Orange, CA.Daily Responsibilities for Medical Case Manager-LTSS: The Medical Case Manager (LTSS) is part of an advanced specialty collaborative practice, responsible for case management, care coordination, authorization and utilization management of the assigned population of focus (Community Based Adult Services (CBAS), CalAIM, complex discharge and long term care (LTC) members residing in nursing facilities under custodial care) including members in the OneCare Programs, Medi-Cal only members or members living in the intermediate care facilities under regional center guidelines. The incumbent will perform utilization functions and authorizations, provide coordination of care and ongoing case management services for CalOptima Health members discharging from LTC facilities. Discharge planning may include services for CalAIM, LTC and CBAS. The incumbent will review and determine medical eligibility based on approved criteria/guidelines, National Committee for Quality Assurance (NCQA) standards, Medicare, Medi-Cal and CDA guidelines and will facilitate communication and coordination among all participants of the health care team and the member to ensure services are provided to promote quality cost-effective outcomes. The incumbent will provide intensive case management in a collaborative process that includes assessment, planning, implementation, coordination, monitoring and evaluation of the member's needs. The incumbent will be the subject matter expert and acts as a liaison to Orange County based community agencies, CalAIM program and providers, CBAS centers, In-Home Support Services (IHSS) liaisons, skilled nursing facilities, members and providers. Shift: M-F, any 8 hour shift between 7am-8pm In-Office positionRequired Qualifications for Medical Case Manager-LTSS: Must complete questionnaire in files tab and upload with resume Associates Degree in Nursing Bachelors preferred RN license in CA 3+ years of experience working either in a clinical environment or for another Managed Care Organization 1+ years of case management Computer Skills - Word, Outlook, Excel, PowerPoint Preferred Qualifications for Medical Case Manager-LTSS: MCO experience Certified Case Manager Certification (CCM) Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese).Benefits for Medical Case Manager-LTSS: Immediate enrollment in Health Insurance Dental Insurance Life Insurance Employee Assistance Program (EAP) Access to Investment Accounts Career and educational tools within our Ingenovis ACT (Advocacy) ProgramPay Details: $43.66/hour - $69.86/hourInterested in being considered?If you are interested in applying to this position, please click Apply Now for immediate consideration. For additional consideration, please email a copy of your resume to karla.roque@healthcaresupport.com with your phone number, the job title and location, and our recruiters will reach out.Healthcare Support Staffing, LLC is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.#SlvRN1124