Care Management Specialist II, D-SNP Team - Los Angeles, CA
1 month ago

Job summary
The Care Management Specialist II 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.
Responsibilities
- Clinically analyzes cases involving highly acute physical health, behavioral health, complex/catastrophic issues.
- Triages immediate member health safety risks.
- Determines effective interventions for high acuity cases.
- Prioritizes caseloads effectively manages multiple tasks simultaneously.Coordinates care across healthcare continuum ensures timely access appropriate services maximizes member benefits serves clinical advocate members active interdisciplinary team liaison other departments external teams uses claims processing software document contacts track progress maintains case information promote coordination records evaluates effectiveness care plans goals interventions regularly identifies complex issues discusses possible solutions management assesses effectiveness action plan produces desired outcomes documents interactions interventions vendors providers maintains case information promotes coordination records provides ongoing direction support internal customers regarding programs processes benefit coverage stays current best practices identifies areas growth opportunities works with management develop plan obtaining necessary training performs other duties assigned.
Job description
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