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

Safety Specialist II – Construction Management

Assists the Senior Construction Safety Project Manager to ensure a safe and heal...

Location

United States , Needham

Salary:

37.76 - 60.41 USD / Hour

Boston Children's Hospital

Expiration Date

Until further notice

Requirements

A high school degree and 3 years of relatable experience and technical training in Life Safety is required
A Bachelor’s degree in Industrial Hygiene, Safety, Occupational Health, or a related scientific field and 1 yr is preferred
Communication skills to effectively deal with conflicting views or issues and mediate fair solutions
Very strong writing and math background for writing policy and compiling/collecting data
OSHA 500 Authorized Trainer, CIC-Certificate in Infection Control is required
Certifications in life safety, emergency response, hazardous materials management and safety management, is preferred

Job Responsibility

Conduct regular inspections of patient and non-patient areas helping to maintain a safe and compliant environment in the hospital
Work tactfully with client depts to ensure that non-compliant situations are addressed
Provide assistance and direction to Safety Specialist I
Assist Sr PM with routine admin tasks
Conduct routine reports, drills, and training for hospital staff
Support existing Construction Safety operations focused on construction permitting (PCRA), ICRA Assessments, contractor eForm submission reviews, Life Safety Compliance (ILSM Alerts), and Fire Stopping Policy compliance
Represent the Environmental Health & Safety (EHS) Department at committee meetings as assigned by the PM and present, take minutes and report back at the request of the PM
Respond to emergencies as a Safety On-Call Officer
Supports existing ICRA 2.0 compliance working with facilities project management, contractors and engineering department management personnel, including providing regular training on policy updates
Assist the Sr PM with high priority projects such as: hazardous drugs training and sampling, hazard assessments, exposure assessments, Environment of Care risks, and maintenance at Hospital satellite locations

What we offer

flexible schedules
affordable health, vision and dental insurance
child care and student loan subsidies
generous levels of time off
403(b) Retirement Savings plan
Pension
Tuition and certain License and Certification Reimbursement
cell phone plan discounts
discounted rates on T-passes

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

Property Administrative Specialist II

Property Administrative Specialist II position at The Ritz-Carlton Aruba, respon...

Location

Aruba

Salary:

Not provided

Marriott Bonvoy

Expiration Date

Until further notice

Requirements

Enter and retrieve information contained in computer databases using keyboard, mouse, or trackball
Update records, files, reservations
Answer inquiries from guests
Transmit information or documents using computer, mail, or facsimile machine
Operate standard office equipment
Prepare letters, memos, and other documents using word processing, spreadsheet, database, or presentation software
Handle incoming and outgoing mail
Create and maintain computer- and paper-based filing systems
Compile, copy, sort, and file records
Enter and locate work-related information using computers and/or point of sale systems

Job Responsibility

Deliver 'Gold Standards' of The Ritz-Carlton graciously and thoughtfully every day
Learn and exemplify Employee Promise, Credo and Service Values
Ensure excellence in the care and comfort of guests
Create experiences so exceptional that long after a guest stays, the experience stays with them

What we offer

Equal opportunity employment
Valued and celebrated unique backgrounds
Creative, thoughtful and compassionate work environment
Chance to be proud of the work you do
Global team belonging
Becoming the best version of you

Fulltime

Provider Enrollment Specialist II - HP Enrollment Eligibility

Coordinates Medicare and Medicaid enrollment/re-enrollment and managed care cred...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

High School Diploma
1-3 years of Payer Enrollment experience
Solid knowledge and utilization of PC applications to include WORD, EXCEL, ACCESS
Excellent written and verbal communication skills
Excellent organization and planning skills with demonstrated teamwork skills
Proven ability to interact with all levels of management and other Associates

Job Responsibility

Collects and maintains data on providers for Medicare and Medicaid enrollment
Prepares and submits applications to Medicare and Medicaid for new provider enrollments and existing provider updates
follows up by telephone or in writing, with carriers regarding application status
Complies with Medicare and Medicaid provider enrollment guidelines
Requests NPI numbers for providers and clinics as necessary and maintains NPI files
Follows up, either by telephone or in writing, with insurance companies and patients regarding the processing of outstanding claims and/or appeals
Generates various reports to identify outstanding claims issues with provider numbers and non-payment
Communicates information to appropriate personnel
Educates staff on corrections, e.g.. front-end entry errors in a positive, constructive manner
Collects and reviews managed care contracts for correct billing and payment terms

Fulltime

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

Clinical Laboratory QC Specialist

The Clinical Laboratory Quality Control (QC) Specialist I performs and functions...

Location

United States , Madison

Salary:

76000.00 - 125000.00 USD / Year

Exact Sciences

Expiration Date

Until further notice

Requirements

Bachelor’s degree in chemical, biological, or clinical laboratory sciences or medical technology from an accredited institution
For a degree not one of those listed above: 90 semester hours which must include 16 semester hours in chemistry (6 of which must be in inorganic chemistry)
16 semester hours in biology courses and 3 semester hours of math
2+ years of experience in a laboratory setting
1+ years of experience performing, reviewing and understanding quality control on a routine basis
Demonstrated ability to perform the Essential Duties of the position with or without accommodation
Authorization to work in the United States without sponsorship

Job Responsibility

All assigned job duties are performed following laboratory policies and procedures
Responsible for running daily QC scripts using statistical software and reviewing generated daily QC data
Responsible for identifying quality control issues, errors, and trends and promptly informing QC Specialist II and/or other QC team members of issues identified
May be requested to assist QC Specialist II and/or other QC team members in investigation of quality control issues, errors, and trends
May be requested to assist QC Specialist II and/or other QC team members in preparation of monthly quality control reports
Responsible for performing validations, verifications, and studies under the guidance of the QC Specialist II and/or other QC team members
Responsible for obtaining validation, verification, and study data for review
May be requested to assist in review of validation, verification, and study data
Assists QC Supervisor, QC Lead, and other QC team members in ensuring that all section turn-around times are maintained
Assists the QC Supervisor, QC Lead, and other QC team members by escalating concerns and answering technical questions from laboratory staff and others in Exact Sciences labs, as appropriate

What we offer

paid time off (including days for vacation, holidays, volunteering, and personal time)
paid leave for parents and caregivers
a retirement savings plan
wellness support
health benefits including medical, prescription drug, dental, and vision coverage
bonus eligible

Fulltime

New

Social Worker II, Ryan White Care Program

The Social Worker II plays a vital role in delivering compassionate, patient‑cen...

Location

United States , Winston Salem

Salary:

30.70 - 46.05 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Master’s degree in Social Work (MSW) from a Council on Social Work Education (CSWE)–accredited program preferred
Consideration will be given to candidates with a master’s degree in a health services–related field or a bachelor’s degree in social work with relevant experience
Social work and/or medical case management experience in a healthcare setting is desirable
Demonstrated ability to provide age‑ and developmentally appropriate care and to work collaboratively within an interdisciplinary team

Job Responsibility

Identify patients who would benefit from medical case management services through initial screening and ongoing assessment
Conduct comprehensive biopsychosocial assessments by interviewing patients and families and evaluating clinical and social determinants of health
Develop, implement, and regularly reassess individualized care plans and acuity scores in accordance with Ryan White program policies and requirements
Provide continuous monitoring of patient progress toward treatment goals and adjust care plans as needed
Initiate and coordinate appropriate internal and external referrals to address medical, psychosocial, financial, and community support needs
Facilitate access to healthcare coverage and medications by collaborating with Patient Navigators and assisting with enrollment in the Healthcare Marketplace, HMAP, co‑payment assistance, patient assistance, and 340B programs
Collaborate with Patient Navigators, Triage Nurses, and Disease Intervention Specialist Bridge Counselors to support patients who are lost to care and promote re‑engagement using evidence‑based treatment and prevention strategies
Advocate on behalf of patients to address unmet needs and reduce barriers to effective care
Participate actively in weekly multidisciplinary team meetings, clinical conferences, staff meetings, and assigned committees or task forces
Collaborate with the care team to develop and implement discharge plans that support patient progression through the continuum of care

What we offer

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
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program
Opportunity for annual increases based on performance
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions

Fulltime

Inventory Specialist II

The Inventory Specialist II at Children’s Hospital Los Angeles is responsible fo...

Location

United States , Los Angeles

Salary:

39603.00 - 65062.00 USD / Year

Children's Hospital Los Angeles

Expiration Date

Until further notice

Requirements

2+ years of experience in inventory management or supply chain roles
Strong knowledge of medical supplies, including preference cards and case cart setups
Proficiency with inventory management software and barcode scanning technologies
Demonstrated problem-solving skills
Considerable, standing, walking, reaching, stooping, bending, kneeling, crouching
Proficient in the safe operation and handling of manual and electric pallet jacks, dollies, and other warehouse transportation equipment
Experienced in moving, loading, and unloading materials efficiently while adhering to safety protocols
Ability to lift and transport supplies up to 60 pounds as needed
Knowledgeable of equipment maintenance procedures and able to perform basic inspections before use
High school diploma or equivalent

Job Responsibility

Overseeing and optimizing inventory management across perioperative and/or distribution service areas
Ensure accurate par-level maintenance, timely replenishment, and financial accountability for medical supplies and implants
Collaborate with clinical, procurement, and supply chain teams to maintain data integrity, resolve stock issues, and support continuous operational improvement
Provide mentorship and training to junior staff, uphold compliance standards, and foster a culture of teamwork to ensure uninterrupted support for patient care areas

What we offer

Competitive compensation package
Robust benefits program

Fulltime

Care Management Specialist II

L.A. Care Health Plan

Location:
United States , Los Angeles

Category:
-

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
February 16, 2026

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