Enhanced Care Management Clinical Specialist II
Job Category: Clinical
Department: Care Management
Location: Los Angeles, CA, US, 90017
Position Type: Full Time
Requisition ID: 11499
Salary 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, we make sure our members get the right care at the right place at the right time.
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 and to support the safety net required to achieve that purpose.
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. The position is responsible for providing oversight, feedback, and technical assistance to ECM Providers to support effective delivery of ECM services and ensure compliance with local, State, and Federal regulations, statutes, and guidelines.
Duties
- Conduct regular monitoring and coaching with Providers to review aggregate progress and individual ECM member cases.
- Provide guidance on best practices to ECM providers.
- Conduct a monthly random sample review of Assessments and Care Plans created by the ECM Provider.
- Identify any gaps in the Care Plan services or regulatory compliance and provide coaching and feedback to the Provider to improve.
- Organize and perform file review processes in accordance with given criteria.
- Provide training, education, and consultation as necessary to Providers.
- Assist ECM Providers with escalation of ECM member cases that require additional assistance from L.A. Care.
- Collaborate with other ECM staff on identifying topics and developing materials for Provider training and capacity building.
- Actively identify and implement efforts to improve the quality, effectiveness, and efficiency of ECM.
- Communicate any barriers to supervisors in an efficient and effective manner.
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 managing complex acute or chronic conditions in collaboration with members and interdisciplinary care professionals in a hospital, medical group, or managed care setting.
Previous care management experience to include auditing/oversight/performance management experience.
Skills
Required:
- Current knowledge of clinical standards of care and disease processes, and community resources.
- Excellent verbal and written communication skills; excellent interpersonal skills.
- Ability to clinically analyze complex cases involving highly acute physical health, behavioral health, and psychosocial issues.
- Proficiency in Microsoft Office applications.
- Maintain confidentiality in compliance with all HIPAA requirements.
- Ability to solve complex issues and identify creative solutions with external agencies.
- Excellent project management skills.
- Working knowledge of Medi-Cal and Medicare regulations.
Preferred: Bilingual in one of LA 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
Light
Additional Information
Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance.
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 Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
#J-18808-Ljbffr
