Care Management Coordinator III (2 Open Positions)

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. Our 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.

About the role

The Care Management Coordinator III serves as the primary liaison for the Department of Health Services (DHS) Emergency Department (ED) Coordination of Care Process and is responsible for the coordination of urgent complex member needs. This position ensures timely case opening, provider and member outreach, and facilitation of specialty authorizations. The Care Management Coordinator III works independently to ensure loop closure with DHS facilities and required documentation for program tracking. This position serves as the subject matter expert on DHS ED referral processing, authorization coordination, and provides guidance to Care Management Coordinator IIs as needed. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.

Responsibilities

• Serves as the primary case owner for high-risk, complex members requiring intensive and ongoing services. Conducts timely telephonic outreach, case identification, thorough documentation, investigation and resolution of complex cases, and follows up with providers, Participating Physician Groups (PPGs) and other departments on behalf of assigned members. (40%)
• Responsible for the timely, end-to-end management of care coordination of DHS cases, including obtaining specialty authorizations, scheduling appointments, initiating the coordination of referrals to internal departments and external community resources, ensuring accurate and compliant documentation, managing computer data input, secure communications, and the organization of confidential member information, as well as maintaining logs of activity. (30%)
• Assigns cases to a Care Management Specialist to assist with care coordination and outreach for high-risk and complex members. Facilitates, documents, schedules, and organizes Interdisciplinary Care Team meetings, manages regulatory notifications by monitoring utilization trends and initiating timely communication with Primary Care Physician (PCP), PPG, and members during a transition of care. (15%)
• Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization, and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed. (5%)
• Performs other duties as assigned. (10%)

Requirements

• High School Diploma or High School Equivalency Certificate. In lieu of degree, equivalent education and/or experience may be considered.
• At least 2 years of experience in healthcare/managed care or medical administration.
• At least 6 months of experience working on care coordination cases directly with members and providers.
• Advanced knowledge of medical terminology.
• Knowledge of health care regulations, and policies and procedures.
• Excellent verbal and written communication skills.
• Advanced proficiency in Microsoft Office with a high level of accuracy.
• Excellent analytical and conflict resolution skills as well as persuasion skills.
• Excellent organizational and time management skills.
• Highly detail-oriented and a team player.
• Excellent customer service skills with compassion and empathy.
• Ability to work with minimal supervision using excellent critical thinking skills.
• Knowledge of utilization management and authorization process.

Preferred Qualifications

• Associate's Degree.
• At least 6 months of experience processing authorizations at a managed care or health plan setting.
• Certified Medical Assistant (CMA).
• Training in Motivation Interviewing or Trauma Informed Care.

Skills

Advanced proficiency in Microsoft Office, excellent analytical and conflict resolution skills, strong organizational and time management abilities, and a high level of detail orientation. Must demonstrate excellent customer service with compassion and empathy, and be able to work independently using critical thinking.

Pay

Salary Range: $55,245.00 (Min.) - $69,045.00 (Mid.) - $82,867.00 (Max.)

Benefits

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental, and Vision
• Wellness Program
• Volunteer Time Off (VTO)

Physical Requirements

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