Managed Long Term Services and Supports Nurse Specialist RN II-
Job Category: Clinical
Department: Managed Long Term Services and Supports
Los Angeles, CA, US, 90017
Position Type: Full Time
Requisition ID: 8493
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 nations largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Cares 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.
As a condition of employment, L.A. Care requires a COVID-19 vaccine. This requirement includes our remote workforce. If you would like to request an exemption, L.A. Care has implemented a process to consider exemptions, for documented medical conditions and sincerely held religious beliefs. L.A. Care will review all exemption requests prior to proceeding with the recruitment process.
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.
Collaborate with Skilled Nursing Facilities (SNF), Community Based Adult Services (CBAS) Centers, Preferred Provider Groups (PPG), Care Management and Social Services to facilitate authorization of services. Coordinate the identification, documentation, and resolution of related issues in a timely manner.
Responsible for performing assessments of members referred to MLTSS programs for the identification, evaluation, coordination and management of members' needs, including physical health, behavioral health, social services, and MLTSS.
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 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. 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.
Associate's Degree in Nursing
Bachelor's Degree in Nursing
At least 5-7 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. 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.
Experience in utilization review, skilled nursing, home health, discharge planning, behavioral health, community resources, and/or other home and community-based agencies.
Excellent verbal and written communication skills.
Excellent organizational and time-management skills.
Proficient in Microsoft Office.
Registered Nurse (RN) - Active, current and unrestricted California License
Registered Nurse (RN)
Travel to offsite locations for work.
Job may require travel to facilities, CBAS Centers and Skilled Nursing Facilities.
L.A. Care offers a wide range of benefits including
At L.A. Care, we value our team members safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.
- Ambulatory Care
- Behavioral Medicine
- Care Coordination
- Case Management
- Certified Nurse Practitioner