Managed Long Term Services and Supports Nurse Specialist RN II
About the Role
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. Utilizes assessments, member-centered care planning, direct provider coordination/collaboration, and psychosocial wraparound services to promote effective utilization of available Health Plan benefits including, but not limited to:
- Community Based Adult Services (CBAS)
- Skilled Nursing Facility (SNF) services
- Intermediate Care Facility for Developmentally Disabled (ICF/DD) services
- CalAIM Community Supports
- Palliative and Hospice Care
Scope of work includes care coordination functions and must adhere to regulatory mandates that apply to Utilization Management (UM) and Care Management (CM).
Responsibilities
- Apply advanced clinical judgment and critical thinking to coordinate care for members
- Conduct assessments and develop member-centered care plans
- Coordinate and collaborate with providers and social services
- Promote effective utilization of Health Plan benefits
- Adhere to regulatory mandates for Utilization Management (UM) and Care Management (CM)
Requirements
- Associate's Degree in Nursing (Required)
- Bachelor's Degree in Nursing (Preferred)
- At least 3 years of clinical nursing experience in direct patient care, such as ambulatory care, home care, palliative care, or hospice care
- Experience in Utilization Review or Care Management may substitute for direct patient care
- Relevant Licensed Vocational Nurse (LVN) experience in a UM or CM capacity may substitute for 1 year of RN experience (2 years LVN = 1 year RN)
- Clinical experience working with individuals with chronic illnesses, comorbidities, and/or disabilities in a UM/CM environment
Preferred Qualifications
- Experience in utilization review, skilled nursing, home health, discharge planning, behavioral health, community resources, and/or other home and community-based agencies
About the Organization
As the nation's largest publicly-operated health plan, we have a great responsibility to the communities we serve. Our employees play an essential role in ensuring we meet those needs.
Benefits
- Great compensation and benefits
- Supportive management team
- Opportunities for career growth
- Camaraderie and a true sense of mission
Pay
Pay Range: $88,854.00 (Minimum) - $115,509.00 (Midpoint) - $142,166.00 (Maximum)
Location: Los Angeles, 90017