L.A. Care Health Plan
Enhanced Care Management Clinical Specialist II
L.A. Care Health Plan, Los Angeles, California, United States, 90079
Enhanced Care Management Clinical Specialist II
Job Category: ClinicalDepartment: Care ManagementLocation: Los Angeles, CA, US, 90017Position Type: Full TimeRequisition ID: 11499Salary Range:
$88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan, serving more than 2 million members.Mission:
L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities.The Enhanced Care Management (ECM) Clinical Specialist II is responsible for the management and oversight activities associated with L.A. Care's ECM network. The position reports to the Supervisor of ECM and receives clinical supervision as needed from the Medical Director of Care Management. Responsibilities include providing oversight, feedback, and technical assistance to ECM Providers, conducting regular meetings, reviewing Assessments & Care Plans, and assisting with case escalations.Duties
Conduct regular monitoring and coaching with Providers to review aggregate progress and individual ECM member cases.Conduct a monthly random sample review of Assessments and Care Plans created by the ECM Provider.Provide training, education, and consultation as necessary to Providers.Assist ECM Providers with escalation of ECM member cases.Collaborate with internal and external providers for coordination of member care.Identify and implement efforts to improve the quality, effectiveness, and efficiency of ECM.Perform other duties as assigned.Education Required
Associate's Degree in Nursing or Master's Degree in Social Work for Licensed Clinical Social Workers.Education Preferred
Bachelor's Degree in Nursing.Experience
Required:
Minimum 3 years of recent care management experience with responsibilities of managing complex conditions.Skills
Required:Current knowledge of clinical standards of care and disease processes.Excellent verbal and written communication skills.Ability to analyze complex cases and determine effective member-centered interventions.Proficiency in Microsoft Office applications.Maintain confidentiality in compliance with HIPAA requirements.Excellent project management skills.Preferred:
Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable.Licenses/Certifications Required
Licensed Clinical Social Worker (LCSW) or Registered Nurse (RN); current and unrestricted California License.Licenses/Certifications Preferred
Certified Professional in Utilization Review (CPUR).Physical Requirements
LightAdditional Information
Preferred:
Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM).Salary Range Disclaimer:
The expected pay range is based on many factors and is subject to change.L.A. Care offers a wide range of benefits including:Paid Time Off (PTO)Tuition ReimbursementRetirement PlansMedical, Dental and VisionWellness Program
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Job Category: ClinicalDepartment: Care ManagementLocation: Los Angeles, CA, US, 90017Position Type: Full TimeRequisition ID: 11499Salary Range:
$88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan, serving more than 2 million members.Mission:
L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities.The Enhanced Care Management (ECM) Clinical Specialist II is responsible for the management and oversight activities associated with L.A. Care's ECM network. The position reports to the Supervisor of ECM and receives clinical supervision as needed from the Medical Director of Care Management. Responsibilities include providing oversight, feedback, and technical assistance to ECM Providers, conducting regular meetings, reviewing Assessments & Care Plans, and assisting with case escalations.Duties
Conduct regular monitoring and coaching with Providers to review aggregate progress and individual ECM member cases.Conduct a monthly random sample review of Assessments and Care Plans created by the ECM Provider.Provide training, education, and consultation as necessary to Providers.Assist ECM Providers with escalation of ECM member cases.Collaborate with internal and external providers for coordination of member care.Identify and implement efforts to improve the quality, effectiveness, and efficiency of ECM.Perform other duties as assigned.Education Required
Associate's Degree in Nursing or Master's Degree in Social Work for Licensed Clinical Social Workers.Education Preferred
Bachelor's Degree in Nursing.Experience
Required:
Minimum 3 years of recent care management experience with responsibilities of managing complex conditions.Skills
Required:Current knowledge of clinical standards of care and disease processes.Excellent verbal and written communication skills.Ability to analyze complex cases and determine effective member-centered interventions.Proficiency in Microsoft Office applications.Maintain confidentiality in compliance with HIPAA requirements.Excellent project management skills.Preferred:
Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable.Licenses/Certifications Required
Licensed Clinical Social Worker (LCSW) or Registered Nurse (RN); current and unrestricted California License.Licenses/Certifications Preferred
Certified Professional in Utilization Review (CPUR).Physical Requirements
LightAdditional Information
Preferred:
Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM).Salary Range Disclaimer:
The expected pay range is based on many factors and is subject to change.L.A. Care offers a wide range of benefits including:Paid Time Off (PTO)Tuition ReimbursementRetirement PlansMedical, Dental and VisionWellness Program
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