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Managed Long Term Services and Supports Nurse Specialist RN II
2 months ago
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.
Job Summary
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 coordination of psychosocial wraparound services to promote effective utilization of available Health Plan, Home and Community Based Services (HCBS), and MLTSS resources, optimal member functioning, and cost-effective outcomes. Scope of work includes care coordination functions and must adhere to regulatory mandates that apply to Utilization Management (UM) and Care Management (CM).
Collaborate with Skilled Nursing Facilities (SNF), Intermediate Care Facility - Developmentally Disabled (ICF-DD), Congregate Living Health Facility (CLHF), Community Based Adult Services (CBAS) Centers, Preferred Provider Groups (PPG), CalAIM providers (i.e. Community Supports, ICF-DD, Regional Center), cross functional units Behavioral Health to facilitate authorization of services. Coordinate the identification, documentation, and resolution of related issues in a timely manner.Duties
Responsible for performing assessments of members referred to core MLTSS and other MLTSS administered programs for the identification, evaluation, coordination and management of members' needs, including physical health, behavioral health, social services, and MLTSS. Responsible for UM authorization functions for services requiring prior auths.
Provides direction to non-clinicians who assist members with accessing services. Conducts additional assessments as necessary, to monitor, evaluate and revise members' care plans to meet members' needs, with the goal of optimizing member health care across the care continuum. Arranges for all services required while coordinating with the health care team to eliminate duplication of services.
Interfaces with Medical Directors, social workers, and interdisciplinary care team (ICT). Participates in ICT meetings and makes recommendations for MLTSS and other MLTSS administered programs.
Establishes relationships with referral sources and community resources, such as external providers, SNFs, CBAS Centers, PPGs, and care coordinators, while maintaining strict member confidentiality and complying with all Health Insurance Portability and Accountability Act (HIPAA) requirements.
Facilitates care coordination with internal and external entities to improve member's short and long term goals in collaboration with member, caregivers, family, support systems, and physicians. A person-centered approach will minimize member confusion, and ensure that the best care is delivered in the most appropriate setting.
Performs clinical review of SNF and CBAS services and determines if the request is appropriate level of care. Reviews requests for PCHS and Respite to determine appropriateness of the request. Evaluates if needs can be addressed through other avenues, such as, community services, HCBS and covered health plan benefits, and makes referrals to appropriate programs.
Documents accurately and comprehensively based on the standards of practice and current organization policies.
Performs other duties as assigned. Duties ContinuedEducation RequiredAssociate's Degree in NursingEducation PreferredBachelor's Degree in NursingExperience
Required:
At least 5 years of clinical nursing experience in direct patient care, such as ambulatory care, home care, or case management. OR experience in Utilization Review or Care Management will be considered in lieu of direct patient care. At least 3 years of relevant Licensed Vocational Nurse (LVN) experience may be substituted for 2 years of RN experience.
Clinical experience working with individuals with chronic illnesses, comorbidities, and/or disabilities in a case/care management environment.
Preferred:
Experience in utilization review, skilled nursing, home health, discharge planning, behavioral health, community resources, and/or other home and community-based agencies.Skills
Required:
Excellent verbal and written communication skills.
Excellent organizational and time-management skills.
Proficient in Microsoft Office.
Preferred:
Bilingual in one of LA Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.Licenses/Certifications RequiredRegistered Nurse (RN) - Active, current and unrestricted California LicenseLicenses/Certifications PreferredRequired Training
Required:
Registered Nurse (RN)Physical RequirementsLightAdditional Information
Required:
Travel to offsite locations for work.
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 ReimbursementRetirement PlansMedical, Dental and VisionWellness ProgramVolunteer Time Off (VTO)