Lead UM Care Management Specialist 8/11/2016

Confidential Company Los Angeles, CA

Company
Confidential Company
Job Classification
Full Time
Company Ref #
28728225
AJE Ref #
575853939
Location
Los Angeles, CA
Job Type
Regular

JOB DESCRIPTION

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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.

RESPONSIBILITIES:

* 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

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

LICENSES/CERTIFICATIONS
Required:
Registered Nurse with an active, current, unrestricted California nursing license and valid California Driver's License