Working Nurse
Care Management Specialist II, D-SNP Team (ALD)
Working Nurse, Los Angeles, California, United States, 90079
Care Management Specialist II, D-SNP Team (ALD)
Apply for the
Care Management Specialist II, D-SNP Team (ALD)
role at
Working Nurse .
Job ID:
12475
Location:
Los Angeles, 90017
Shift:
Full Time
Pay Range:
$88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)
Job Description The Care Management Specialist II utilizes clinical skills and training to perform essential functions of care management for an identified and assigned member population according to Health Insurance Portability and Accountability Act (HIPAA) guidelines. They manage a specified caseload across the entire continuum of programmatic levels, including National Committee for Quality Assurance (NCQA) scope or otherwise Complex/Catastrophic cases, requiring the highest clinical skills and judgment.
Responsibilities include coordinating health care benefits, providing education, facilitating member access to care in a timely and cost-effective manner and collaborating with members, families, and interdisciplinary health teams to promote wellness and empowerment. They serve as a clinical advocate, active interdisciplinary team member, and liaison with other departments and external healthcare teams, using claims processing and care management software to evaluate member information.
They provide direction and assistance to Care Coordinators and Community Health Workers (CHW) regarding special educational mailings, reminder calls, satisfaction surveys, incentives, or any additional service needs according to specific program guidelines.
Qualifications Education Required
Associate's Degree in Nursing (Registered Nurses)
Master's Degree in Social Work (Licensed Clinical Social Workers)
Education Preferred
Bachelor's Degree in Nursing (Registered Nurses)
Experience Required
Minimum of 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, such as a health insurance environment and/or experience as a care manager in home health or hospice environments.
Experience providing care management with complex/catastrophic conditions.
About The Hospital As the nation's largest publicly‑operated health plan, we have a great responsibility to the communities we serve, and our employees play an essential role in ensuring we meet those needs.
Why Join Us? Opportunity. Amazing co‑workers. A supportive management team. Great compensation and benefits. Camaraderie and a true sense of mission. If you want a career that truly contributes to the good of all, join us as we work towards a healthier L.A.
Seniority level:
Mid‑Senior level
Employment type:
Full‑time
Job function:
Health Care Provider
Industries:
Hospitals and Health Care
Referrals increase your chances of interviewing at Working Nurse by 2x.
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Care Management Specialist II, D-SNP Team (ALD)
role at
Working Nurse .
Job ID:
12475
Location:
Los Angeles, 90017
Shift:
Full Time
Pay Range:
$88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)
Job Description The Care Management Specialist II utilizes clinical skills and training to perform essential functions of care management for an identified and assigned member population according to Health Insurance Portability and Accountability Act (HIPAA) guidelines. They manage a specified caseload across the entire continuum of programmatic levels, including National Committee for Quality Assurance (NCQA) scope or otherwise Complex/Catastrophic cases, requiring the highest clinical skills and judgment.
Responsibilities include coordinating health care benefits, providing education, facilitating member access to care in a timely and cost-effective manner and collaborating with members, families, and interdisciplinary health teams to promote wellness and empowerment. They serve as a clinical advocate, active interdisciplinary team member, and liaison with other departments and external healthcare teams, using claims processing and care management software to evaluate member information.
They provide direction and assistance to Care Coordinators and Community Health Workers (CHW) regarding special educational mailings, reminder calls, satisfaction surveys, incentives, or any additional service needs according to specific program guidelines.
Qualifications Education Required
Associate's Degree in Nursing (Registered Nurses)
Master's Degree in Social Work (Licensed Clinical Social Workers)
Education Preferred
Bachelor's Degree in Nursing (Registered Nurses)
Experience Required
Minimum of 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, such as a health insurance environment and/or experience as a care manager in home health or hospice environments.
Experience providing care management with complex/catastrophic conditions.
About The Hospital As the nation's largest publicly‑operated health plan, we have a great responsibility to the communities we serve, and our employees play an essential role in ensuring we meet those needs.
Why Join Us? Opportunity. Amazing co‑workers. A supportive management team. Great compensation and benefits. Camaraderie and a true sense of mission. If you want a career that truly contributes to the good of all, join us as we work towards a healthier L.A.
Seniority level:
Mid‑Senior level
Employment type:
Full‑time
Job function:
Health Care Provider
Industries:
Hospitals and Health Care
Referrals increase your chances of interviewing at Working Nurse by 2x.
#J-18808-Ljbffr