Care Management Specialist II

Salary Range

Min.$88,854.00 Mid.$115,509.00 Max.$142,166.00

About the role

L.A. Care Health Plan is an independent public agency established in 1997 to provide health coverage to low-income Los Angeles County residents. We serve more than 2 million members and aim to ensure they receive quality health care.

Job Summary

The Care Management Specialist II performs essential functions of care management for identified and assigned member population, applying clinical skills and training to meet member needs according to HIPAA guidelines. This role manages a caseload of complex and vulnerable members, collaborating with interdisciplinary teams and providing comprehensive care management services.

Responsibilities

• Evaluates information from various sources to determine if care management intervention is necessary.
• Engages in member-centric communication with interdisciplinary teams, providers, and family members.
• Conducts comprehensive clinical assessments and develops member-centric plans of care.
• Provides education and resources to members about accessing services and making informed decisions.
• Monitors and evaluates member progress, refining action plans to achieve desired outcomes.
• Documents interactions and interventions using claims and care management software.
• Maintains case information in clinical records to promote care coordination.
• Provides ongoing direction and support to internal customers regarding Care Management programs.

Requirements

• Minimum of 3 years of recent care management experience with responsibilities of managing complex acute or chronic conditions.
• Experience providing care management with complex/catastrophic conditions.
• Current knowledge of clinical standards of care and disease processes.
• Critical thinking skills.
• Excellent customer service skills.
• Ability to clinically analyze complex cases and implement effective interventions.
• Strong verbal and written communications skills.
• Knowledge of community resources and Medi-Cal/Medicare regulations.
• Ability to work as part of a diverse team and gain consensus on problem-solving.

Qualifications

• Associate's Degree in Nursing for Registered Nurses.
• Master's Degree in Social Work for Licensed Clinical Social Workers.

Skills

• Current knowledge of clinical standards of care and disease processes.
• Critical thinking skills.
• Excellent customer service skills.
• Ability to clinically analyze the most complex cases involving highly acute physical health, behavioral health, complex/catastrophic and/or psychosocial issues.
• Ability to triage immediate member health and safety risks.
• Ability to sensitively manage member or family responses associated with high acuity cases and support effective coping.
• Strong verbal and written communications skills.
• Ability to use a personal computer and knowledge of medical information systems.
• Knowledge of and ability to comply with HIPAA compliance.
• Ability to interview, assess, and coordinate care.
• Ability to prioritize caseload.
• Knowledge of community resources.
• Knowledge of Medi-Cal and Medicare regulations.
• Ability to work as a part of a diverse team and gain consensus and resolution of problems.

Benefits

L.A. Care offers a wide range of benefits including paid time off, tuition reimbursement, retirement plans, medical, dental, and vision coverage, wellness programs, volunteer time off, and more.

Pay

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

Schedule

Travel to offsite locations for work is required.