Lead UM Care Management Specialist

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POST DATE 8/11/2016
END DATE 12/19/2016

Confidential Company Los Angeles, CA

Los Angeles, CA
AJE Ref #
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Full Time
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The LEAD UM CARE MANAGEMENT SPECIALIST is a lead position responsible for the program development of the Disease Management (DM) programs and/or Care Management (CM) programs.


* Program development, technology implementation and integrity, ensuring regulatory and Accreditation compliance, program utilization and outcome reporting.
* Assure all functions are operating in accordance with the organization's mission, values and strategic goals; are focused on continuous improvement and provided in a manner that is responsive and culturally sensitive to the needs of Client's diverse membership.
* Maintain a caseload as defined by the UM Director.
* Collaborated with the Primary Care Provider (PCP) and other treatment professionals
* Perform telephonic physical, functional and psycho-social assessments

QUALIFICATIONS Utilization Management/Case Management experience - 5 years
* HMO managed care with prior experience in ambulatory case management, disease management or any combination of education/experience which would provide an equivalent background
* Strong clinical skills with a knowledge of behavioral assessment techniques
* Knowledge of health and/or patient education and behavioral change techniques
* Proficiency with Microsoft Office (Excel, Word, Access, etc)
* Excellent interpersonal and communication skills
* Good working knowledge of regulatory requirements/standards
* Computer literacy and adaptability to computer learning
* Time management and priority-setting skills.
* Previous experience in a health plan developing and performing UM case management/disease management
* Experience working with the Medi-Cal and Medicare populations

Bachelor's Degree in Nursing or Master's Degree in Nursing, Health Administration, Public Health or related healthcare field.

Registered Nurse with an active, current, unrestricted California nursing license and valid California Driver's License