L.A. Care Health Plan
Managed Long Term Services and Supports Nurse Specialist RN II
L.A. Care Health Plan, Los Angeles, California, United States, 90079
Managed Long Term Services and Supports Nurse Specialist RN II
Job Category:
ClinicalDepartment:
Managed Long Term Services and SupportsLocation:
Los Angeles, CA, US, 90017Position Type:
Full TimeRequisition ID:
11586Salary 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 and residents.The Managed Long Term Services and Supports (MLTSS) Nurse Specialist RN II applies advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare and social services for L.A. Care members. Responsibilities include care coordination functions adhering to regulatory mandates that apply to Utilization Management (UM) and Care Management (CM).Duties
Responsible for performing assessments of members referred to core MLTSS and other MLTSS administered programs for the identification, evaluation, coordination, and management of members' needs, including physical health, behavioral health, social services, and MLTSS. Responsible for UM authorization functions for services requiring prior authorizations.Provides direction to non-clinicians who assist members with accessing services. Conducts additional assessments as necessary to monitor, evaluate, and revise members' care plans to meet members' needs, with the goal of optimizing member health care across the care continuum.Interfaces with Medical Directors, social workers, and interdisciplinary care team (ICT). Participates in ICT meetings and makes recommendations for MLTSS and other MLTSS administered programs.Establishes relationships with referral sources and community resources, such as external providers, SNFs, CBAS Centers, PPGs, and care coordinators, while maintaining strict member confidentiality and complying with all Health Insurance Portability and Accountability Act (HIPAA) requirements.Facilitates care coordination with internal and external entities to improve member's short and long-term goals in collaboration with members, caregivers, family, support systems, and physicians.Performs clinical reviews of SNF and CBAS services and determines if the request is appropriate level of care. Reviews requests for PCHS and Respite to determine appropriateness of the request.Documents accurately and comprehensively based on the standards of practice and current organization policies.Performs other duties as assigned.Education Required
Associate's Degree in NursingEducation Preferred
Bachelor's Degree in NursingExperience
Required:
At least 5 years of clinical nursing experience in direct patient care, such as ambulatory care, home care, or case management. OR experience in Utilization Review or Care Management will be considered in lieu of direct patient care. At least 3 years of relevant Licensed Vocational Nurse (LVN) experience may be substituted for 2 years of RN experience.Clinical experience working with individuals with chronic illnesses, comorbidities, and/or disabilities in a case/care management environment.Preferred:
Experience in utilization review, skilled nursing, home health, discharge planning, behavioral health, community resources, and/or other home and community-based agencies.Skills
Required:Excellent verbal and written communication skills.Excellent organizational and time-management skills.Proficient in Microsoft Office.Preferred:Bilingual in one of LA Care Health Plan’s threshold languages is highly desirable.Licenses/Certifications Required
Registered Nurse (RN) - Active, current, and unrestricted California LicensePhysical Requirements
LightAdditional Information
Required:
Travel to offsite locations for work.Salary Range Disclaimer:
The expected pay range is based on many factors such as geography, experience, education, and the market. The range 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:
Managed Long Term Services and SupportsLocation:
Los Angeles, CA, US, 90017Position Type:
Full TimeRequisition ID:
11586Salary 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 and residents.The Managed Long Term Services and Supports (MLTSS) Nurse Specialist RN II applies advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare and social services for L.A. Care members. Responsibilities include care coordination functions adhering to regulatory mandates that apply to Utilization Management (UM) and Care Management (CM).Duties
Responsible for performing assessments of members referred to core MLTSS and other MLTSS administered programs for the identification, evaluation, coordination, and management of members' needs, including physical health, behavioral health, social services, and MLTSS. Responsible for UM authorization functions for services requiring prior authorizations.Provides direction to non-clinicians who assist members with accessing services. Conducts additional assessments as necessary to monitor, evaluate, and revise members' care plans to meet members' needs, with the goal of optimizing member health care across the care continuum.Interfaces with Medical Directors, social workers, and interdisciplinary care team (ICT). Participates in ICT meetings and makes recommendations for MLTSS and other MLTSS administered programs.Establishes relationships with referral sources and community resources, such as external providers, SNFs, CBAS Centers, PPGs, and care coordinators, while maintaining strict member confidentiality and complying with all Health Insurance Portability and Accountability Act (HIPAA) requirements.Facilitates care coordination with internal and external entities to improve member's short and long-term goals in collaboration with members, caregivers, family, support systems, and physicians.Performs clinical reviews of SNF and CBAS services and determines if the request is appropriate level of care. Reviews requests for PCHS and Respite to determine appropriateness of the request.Documents accurately and comprehensively based on the standards of practice and current organization policies.Performs other duties as assigned.Education Required
Associate's Degree in NursingEducation Preferred
Bachelor's Degree in NursingExperience
Required:
At least 5 years of clinical nursing experience in direct patient care, such as ambulatory care, home care, or case management. OR experience in Utilization Review or Care Management will be considered in lieu of direct patient care. At least 3 years of relevant Licensed Vocational Nurse (LVN) experience may be substituted for 2 years of RN experience.Clinical experience working with individuals with chronic illnesses, comorbidities, and/or disabilities in a case/care management environment.Preferred:
Experience in utilization review, skilled nursing, home health, discharge planning, behavioral health, community resources, and/or other home and community-based agencies.Skills
Required:Excellent verbal and written communication skills.Excellent organizational and time-management skills.Proficient in Microsoft Office.Preferred:Bilingual in one of LA Care Health Plan’s threshold languages is highly desirable.Licenses/Certifications Required
Registered Nurse (RN) - Active, current, and unrestricted California LicensePhysical Requirements
LightAdditional Information
Required:
Travel to offsite locations for work.Salary Range Disclaimer:
The expected pay range is based on many factors such as geography, experience, education, and the market. The range 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
#J-18808-Ljbffr