Care Management Community Health Worker II Job at L.A. Care Health Plan (Los Angeles)

Care Management Specialist II, D-SNP Team

The Care Management Specialist II utilizes clinical skills and training to perfo...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing for Registered Nurses OR Master's Degree in Social Work for Licensed Clinical Social Workers
Minimum of 3 years of recent care management experience with responsibilities of managing complex acute or chronic conditions in collaboration with members and interdisciplinary care professionals in a hospital, medical group or managed care setting, such as a health insurance environment and/or experience as care manager in home health or hospice environments
Experience providing care management with complex/catastrophic conditions
Current knowledge of clinical standards of care and disease processes
Critical thinking skill
Excellent customer service skills
Ability to clinically analyze the most complex cases involving highly acute physical health, behavioral health, complex/catastrophic and/or psychosocial issues to determine and implement the most effective member-centered interventions
Ability to triage immediate member health and safety risks
Ability to sensitively manage member or family responses associated with high acuity cases and support effective coping
Strong verbal and written communications skills to consult effectively with interdisciplinary teams, coordinate care with members and their families, and other internal and external stakeholders

Job Responsibility

Utilizes clinical skills and training to perform essential functions of care management for identified and assigned member population according to Health Insurance Portability and Accountability Act (HIPAA) guidelines
Manages a specified caseload across the entire continuum of programmatic levels including those within National Committee for Quality Assurance (NCQA) scope or otherwise Complex/Catastrophic cases
Management of the caseload assigned by Manager includes: coordinating health care benefits, providing education and facilitating member access to care in a timely and cost-effective manner
Collaborates and communicates with member, family, and interdisciplinary health team to promote wellness and member empowerment, while ensuring access to appropriate services across the healthcare continuum and maximizing member benefit
Serves as clinical advocate for members, active interdisciplinary team member, liaison with other departments and external health care team
Provides direction and assistance to Care Coordinators and to Community Health Workers (CHW) of members needs including the need for special educational mailings, reminder calls, satisfaction surveys, incentives or any additional service needs according to specific program guidelines
Uses claims processing and care management software to look up member information, document contacts, and track member progress
Applies clinical knowledge and experience to evaluate information regarding prospective care management members referred by health risk assessment (HRA), risk stratification, predictive modeling, provider’s utilization review vendors, members, Call Center, claims staff, Health Homes Program (HHP) eligibility or other data sources to determine whether care management intervention is necessary to meet the member's needs
Conducts Care Management services for the most complex and vulnerable members including: engaging in member centric communication which includes the interdisciplinary team, providers and family or authorized representatives
reviewing member claims histories and identifies intervention opportunities through the professional standards of practice

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Medical Appeals/Grievance Specialist II - Registered Nurse

Responsible for utilizing clinical acumen and managed care expertise related to ...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

1 year experience in clinical and health insurance or other healthcare related field
3 years experience in clinical and health insurance or other healthcare related field AND 1 year Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
5 years experience in clinical and health insurance or other healthcare related field AND 2 years Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
8 years experience in clinical and health insurance or other healthcare related field AND 3 years above satisfactory job performance in the managed care environment with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
Associate’s Degree in a healthcare field of study or Nursing Diploma
Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) or a compact state as a Registered Nurse (RN), a Physical Therapist (PT) or a Licensed Master Social Worker LMSW.
Intermediate PC proficiency
Intermediate skill using office equipment, including copiers, fax machines, scanner and telephones
Maintain confidentiality and privacy
Advanced clinical knowledge

Job Responsibility

Perform in-depth analysis, clinical review and resolution of provider appeals/inquiries, corrected claims and subscriber reconsiderations, member appeals, corrected claims and provider grievances for all lines of business
Identify, research, process, resolve and respond to customer inquiries primarily through written / verbal communication.
Respond to a diverse and high volume of health insurance appeal related correspondence on a daily basis.
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of appeal, grievance and reconsideration requests.
Maintain complete and accurate records per department policy.
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations.
Demonstrate ability to apply plan policies and procedures effectively.
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
Attend staff and interdepartmental meetings.
Participate in continuing education and current developments in the fields of medicine and managed care.

Fulltime

Transitional Care Services Community Health Worker II

The Transitional Care Services (TCS) Community Health Worker II (CHW) is respons...

Location

United States , Los Angeles

Salary:

55245.00 - 82867.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

High School Diploma/or High School Equivalency Certificate
At least 6 months of experience as a health navigator, peer support worker, outreach worker, promotora, or working in a community setting and providing health education for chronic conditions, or equivalent
Knowledge of community resources for Medi-Cal members
Comfortable working with diverse populations
Exceptional ability to connect and engage with people
Willingness to work in various environments including 1:1 in member’s homes, hospitals, skilled nursing facilities, other clinical settings, and/ or shelters
Excellent verbal and written communication skills
Detail oriented, organized and possess time management skills
Basic computer skills
Must have access to reliable transportation to carry out job-related essential functions

Job Responsibility

Cultural Mediation Among Individuals, Communities, and Health and Social Service Systems: Educating individuals and communities about how to use health and social service systems
Providing Culturally Appropriate Health Education and Information: Conducting health promotion and disease prevention education
Care Coordination, Case Management, and System Navigation: Participating in telephonic and/or in-person care coordination and case management with members, facility staff, and providers
Providing Coaching and Social Support: Providing individual support and coaching
Advocating for Individuals and Communities: Advocating for the needs and perspectives of communities
Building Individual and Community Capacity: Building individual and community capacity by training with peers and among CHW groups
Implementing Individual Assessments: Participating in design, implementation, and interpretation of individual-level assessments
Conducting Outreach: Telephonic and/or in-person recruitment of individuals and families to participate in Transitional Care Services and other supports

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

New

Occupational Therapist II - Inpatient - Float

Occupational Therapist II - Inpatient - Float position at Atrium Health Wake For...

Location

United States , Winston Salem

Salary:

38.20 - 57.30 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Bachelor's degree in Occupational Therapy from an accredited university
Current license to practice Occupational Therapy in the State of applicable state
Basic Cardiac Life Support (BCLS) certification required
Communicates professionally with physicians, nurses, other health care providers and provides quality care for patients
Ability to communicate with patients of all age groups appropriate to the level of comprehension Knowledge, clinical skills, and understanding of the patient throughout the entire span of life
Demonstrates leadership skills required to manage self and teams to accomplish department goals
Flexible
Ability to work effectively with the team

Job Responsibility

Provides patient care assessment and treatment
Maintains accurate documentation
Meets department financial and productivity standards
Participates in process management to optimize quality and efficiency of services
Promotes professional development and education of other health care workers and provides representation on committees
Leads staff and/or program development projects in the areas of strategic effectiveness, clinical outcomes, clinical competency, or financial performance
Communicates effectively. Networks within the occupational therapy profession, other health care professions, and within the community
Provides appropriate patient care in accordance with age/developmental guidelines

What we offer

Day 1 Health Coverage: Choose from either copay or HSA-eligible health insurance options with coverage starting on your first day of work
Generous PTO: Accrual starts at up to 25 days/year, to be used for vacations, sickness, holidays, and personal matters
Parental Benefits: Six weeks paid birthing-mother maternity leave & four weeks paid parental leave for non-birthing parents
Retirement: Up to 7% employer-paid retirement contributions
Education Reimbursement: We invest in your professional growth, offering up to $2,500 per year towards a bachelor's degree and up to $5,000 per year towards a graduate degree
Relocation Assistance: Up to $7,500 in Relocation Assistance (for qualified candidates)
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave

Fulltime

Social Work Consultant

Mental health is an essential component of total health. As mental health profes...

Location

United States , Atlanta

Salary:

37.25 - 48.17 USD / Hour

Kaiser Permanente

Expiration Date

Until further notice

Requirements

Minimum two (2) years social work experience identifying and managing discharge and psychosocial needs of inpatients in an acute care or managed care setting within the last five (5) years
Masters degree in social work conferred by a program accredited by the Council of Social Work Education
Licensed Master Social Worker (Georgia) required at hire OR Associate Marriage and Family Therapist License (Georgia) required at hire OR Associate Professional Counselor License (Georgia) required at hire OR Licensed Clinical Social Worker (Georgia) required at hire
Demonstrated ability to perform on a multidisciplinary team
Must have strong psychosocial assessment skills
Knowledge of chronic and acute disease and how it impacts patient and family functioning
Demonstrated excellent oral/telephone communication skills and written documentation
Must be experienced in documenting in an electronic clinical information system
Must demonstrate ability to effectively and efficiently handle demanding workload involving multiple tasks
Demonstrated ability to function independently as a collaborative, supportive team member

Job Responsibility

Discharge Planning: The primary role of the Medical Social Worker II for hospital settings is to facilitate the execution of approved and appropriate inpatient discharge plans between facilities or into the community
Under general direction of the Continumm of Care Leader and via clear and consistent communication with the onsite care management staff, delivers age-appropriate clinical social work insight and care to members and their caregivers in accordance with agency policy and procedure and state and federal regulations
The Medical Social Worker II serves as an integral member of the healthcare team ensuring coordination of discharge/transition planning and providing referrals to internal resources within the Kaiser Permanente network, information to community resources and other social work services to meet the complex needs of patients and families transitioning from hospital settings
Responsible for overseeing or participating in individual discharge plans which assist members and families to transition to the appropriate level of care upon the completion of the acute Treatment Plan with the measure of restoring social, emotional, financial, and environmental factors which affect and/or affected by the acute inpatient stay
Partners with multidisciplinary teams to identify needs and collaborate and execute individual discharge plans
Discuss options for care proactively including Kaiser resources and external community/government resources to assist member and caregiver(s) in developing short- and long-term care plans as appropriate
Collaborates with other disciplines in assessing, planning, and providing services for patients utilizing biopsychosocial information
Coaches member pre-discharge in advocating for self to receive appropriate services within Kaiser and in the community
Ensures member and caregiver(s) are updated with approved discharge plans
Takes, reviews, evaluates, and prioritizes written and oral referrals

What we offer

Medical, Vision & Dental
Professional Development
Retirement Plans
Vacation, Holiday & Sick Leave
Supportive Teams & Resources

Parttime

Social Work Consultant II

Mental health is an essential component of total health. As mental health profes...

Location

United States , Duluth

Salary:

37.25 - 48.17 USD / Hour

Kaiser Permanente

Expiration Date

Until further notice

Requirements

Minimum two (2) years social work experience identifying and managing discharge and psychosocial needs of inpatients in an acute care or managed care setting within the last five (5) years
Masters degree in social work conferred by a program accredited by the Council of Social Work Education
Licensed Master Social Worker (Georgia) OR Associate Marriage and Family Therapist License (Georgia) OR Associate Professional Counselor License (Georgia) OR Licensed Clinical Social Worker (Georgia)
Demonstrated ability to perform on a multidisciplinary team
Must have strong psychosocial assessment skills
Knowledge of chronic and acute disease and how it impacts patient and family functioning
Demonstrated excellent oral/telephone communication skills and written documentation
Must be experienced in documenting in an electronic clinical information system
Must demonstrate ability to effectively and efficiently handle demanding workload involving multiple tasks
Demonstrated ability to function independently as a collaborative, supportive team member

Job Responsibility

Discharge Planning: The primary role of the Medical Social Worker II for hospital settings is to facilitate the execution of approved and appropriate inpatient discharge plans between facilities or into the community
Responsible for overseeing or participating in individual discharge plans which assist members and families to transition to the appropriate level of care
Partners with multidisciplinary teams to identify needs and collaborate and execute individual discharge plans
Discuss options for care proactively including Kaiser resources and external community/government resources to assist member and caregiver(s) in developing short- and long-term care plans as appropriate
Collaborates with other disciplines in assessing, planning, and providing services for patients utilizing biopsychosocial information
Coaches member pre-discharge in advocating for self to receive appropriate services within Kaiser and in the community
Ensures member and caregiver(s) are updated with approved discharge plans
Takes, reviews, evaluates, and prioritizes written and oral referrals
Maintains documentation, records, and data collections
Responsible for completion of required documents in a complete and timely manner

What we offer

Medical, Vision & Dental
Professional Development
Retirement Plans
Vacation, Holiday & Sick Leave
Supportive Teams & Resources

New

Clinical Social Worker II

The Clinical Social Worker II provides a wide variety of professional social wor...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Master's Degree in Social Work
At least 3 years of experience working with adults, seniors, persons with disabilities, individuals with chronic health conditions, and/or dually diagnosed individuals in health care setting or social agency
Knowledge of managed care and an understanding of Medi-Cal and Medicare programs
Must be highly motivated and a self-starter
The ability to communicate with and relate to a diverse group of people including clients, community, and other staff
Must have excellent administrative and organizational skills
Strong customer services and excellent verbal and written communication skills
Strong analytical, conflict resolutions and persuasion skills
Proficiency with Microsoft Office including Outlook, Word, and Excel
Ability to effectively negotiate with internal and external providers of patient care services

Job Responsibility

Performs a wide variety of professional social work services within the department and organization to support special programs and initiatives
Performs project based activities including program support to ensure successful development/implementation of existing and emerging initiatives
Participates in professional committees, meetings and conferences, related to the special projects and initiatives in Social Services
Manages projects assigned to ensure compliance with program policy
Acts as Subject Matter Expert and provides leadership and guidance to represent special projects and initiatives within Social Services
Analyzes data and produces reports to the department and the leadership team to help manage the projects service delivery
Develops and maintains effective working relationships with other services areas within the organization and external partners
Serves as a liaison between Social Services Department and external partners
Interviews individuals, their families, and/or caregivers to complete psychosocial assessment
Identifies and analyzes the member's needs for services

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Oncology NP/PA

In collaboration with a physician, the Oncology NP/PA manages outpatient care. T...

Location

United States , Foxborough

Salary:

105976.00 - 160347.20 USD / Year

Dana-Farber Cancer Institute

Expiration Date

Until further notice

Requirements

Authorization to practice in an expanded role as a Nurse Practitioner in the Commonwealth of Massachusetts
Current certification from a nationally recognized accrediting body approved by the Massachusetts Board of Registration in Nursing for Nurse Practitioners
Minimum of 24 contact hours beyond generic education in pharmacotherapeutics
Masters degree in Nursing
Minimum of 1 year oncology nursing experience or 1 year Nurse Practitioner experience
In possession of Massachusetts Department of Public Health and Federal DEA numbers
A Masters Degree and successful completion of an AAPA/NCCPA accredited Physician Assistant Studies program are required
Must be NCCPA Certified and licensed to practice as a Physician Assistant in Massachusetts
Must maintain current DEA and Massachusetts Controlled Substance Licenses, and complete 100 hours of CME according to national and state regulations during each 2 year period of employment

Job Responsibility

Manages outpatient care in collaboration with a physician
Responsible for acute and chronic problems associated with disease, treatment and/or conditions
Provides anticipatory guidance, patient and family education, and psychological and emotional support
Has prescriptive authority which includes schedule II through V controlled substances in the Commonwealth of Massachusetts
Member of an interdisciplinary care team that requires effective communication and collaboration with co-workers at the Institute in addition to collaborating institutions and agencies
Role requires critical thinking, an understanding of research principles and practices and leadership that improves the quality of care and advances nursing/medical care within the work setting and throughout the community

Fulltime

Care Management Community Health Worker II

L.A. Care Health Plan

Location:
United States , Los Angeles

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
December 29, 2025

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