Manager, MLTSS Clinical

LA Care Health Plan   •  

Los Angeles, CA

Industry: Healthcare

  •  

5 - 7 years

Posted 48 days ago

Job Summary

The Manager, MLTSS Clinical manages and supervises the day-to-day clinical operations of CBAS and LTC Nurse Specialists. Responsible for ensuring onsite visits to CBAS centers and LTC facilities are timely. Reviews onsite visit reports and member engagement forms to identify quality of care and health and safety concerns. Monitors processes and modifies as needed to maximize efficiency. Validates regulatory and organizational reports and dashboards specific to CBAS and LTC prior to reporting. Provides consultation to Nurse Specialists regarding issues identified during visits. Notifies and collaborates with L.A. Care departments, regulatory agencies and other external organizations as needed for identified issues. Provides support to MLTSS Director in managing MLTSS clinical areas.

Duties

Direct supervision, monitoring and oversight of CBAS and LTC Nurse Specialists.

Assigns Nurse Specialists by Service Planning Areas (SPA) taking into account the member census at each center/facility and level of Nurse Specialist staffing.

Oversees and ensures program compliance with regulatory and waiver requirements.

Supervise and monitor Nurse Specialist’s productivity by reviewing travel and productivity logs.

Develops and maintains active communication with contracted vendors, CBAS centers, LTC facilities, . Provide training on L.A. Care, MLTSS and other benefits available to members.

Assures appropriate departmental interface with utilization management, care management, provider network management, quality improvement, regulatory affairs and compliance, clinical assurance, medical directors and physician advisers. Provides training to other departments regarding the L.A. Care benefit.

Maintain contact and develop relationships with California Department of Aging and Department of Health Care Services.

Maintain contact and develop relationships with business trade organizations such as CAADS (California Association of Adult Day Services) and CAHF (California Association of Health Facilities).

Develop and maintain a culturally sensitive work environment.

Perform other duties as assigned

Education

Bachelor's Degree in Nursing (RN and/or LVN)

Experience

Required:
With Bachelor's Degree: Minimum of 6-8 Community Based Adult (CBAS), Long Term Care (LTC) services, Utilization Management and/or Care Management experience with 3-5 years of progressive management experience.

Experience with state Medi-Cal regulations and requirements.

Required:
Active & Current Driver's License and Auto Insurance Required.

Required:
Excellent written and oral skills. Strong problem solving, planning and organizational skills.

Knowledge of Utilization Management and Case Management activities.

In-depth knowledge of CBAS and LTC services.

Professional Licenses

Current and unrestricted CA RN License