RN or LCSW Case Manager - LTSS, Medicaid, Los Angeles, CA - 82020SY
WellPoint - Los Angeles, CA

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WellPoint is one of the nation's leading health benefits companies and a Fortune Top 50 company. At WellPoint, we are working together to transform health care with trusted and caring solutions.

Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people?s lives, and to take your career further than you can imagine.

These positions will be located in the North Hollywood, CA office and will cover the Los Angeles area.

Responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. Coordinates internal and external resources to meet identified needs. Monitors and evaluates effectiveness of the care management plan and modifies as necessary.

Responsible for identifying members with potential for high risk complications (such as nursing home admissions) and using knowledge in coordinating appropriate treatment in conjunction with the member and the health care team

Responsible for managing members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health services. Seeks to coordinate creative solutions to members? health care needs while optimizing efficiency and quality outcomes.

Obtains a thorough and accurate member history including physical, behavioral, social, biopsychosocial, and environmental factors, and collaborates with the member?s PCP or treating physician and specialists in the development of an Individual Service Plan.

Conducts ongoing member assessments to include implementation, coordination, monitoring and evaluation. Utilizes critical thinking skills and applicable managed care criteria to evaluate and identify needs for home and community-based services and/or skilled needs.

Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians, etc. that meet the member?s needs; identifies members that would benefit from alternative level of care or other waiver programs and develops an Individual Service Plan based on member needs.

Reviews benefit options, acquire data and evaluates necessary services for appropriateness; documents effectiveness of service coordination activities.

Other duties as requested or assigned. WellPoint is one of the nation's leading health benefits companies and a Fortune Top 50 company. At WellPoint, we are working together to transform health care with trusted and caring solutions.

Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people?s lives, and to take your career further than you can imagine.

These positions will be located in the North Hollywood, CA office and will cover the Los Angeles area.

Responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. Coordinates internal and external resources to meet identified needs. Monitors and evaluates effectiveness of the care management plan and modifies as necessary.

Responsible for identifying members with potential for high risk complications (such as nursing home admissions) and using knowledge in coordinating appropriate treatment in conjunction with the member and the health care team

Responsible for managing members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health services. Seeks to coordinate creative solutions to members? health care needs while optimizing efficiency and quality outcomes.

Obtains a thorough and accurate member history including physical, behavioral, social, biopsychosocial, and environmental factors, and collaborates with the member?s PCP or treating physician and specialists in the development of an Individual Service Plan.

Conducts ongoing member assessments to include implementation, coordination, monitoring and evaluation. Utilizes critical thinking skills and applicable managed care criteria to evaluate and identify needs for home and community-based services and/or skilled needs.

Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians, etc. that meet the member?s needs; identifies members that would benefit from alternative level of care or other waiver programs and develops an Individual Service Plan based on member needs.

Reviews benefit options, acquire data and evaluates necessary services for appropriateness; documents effectiveness of service coordination activities.

Other duties as requested or assigned.

WellPoint - 7 months ago - save job - block
About this company
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WellPoint, Inc. (WellPoint) is a health benefits company serving 35 million medical members, as of December 31, 2008. The Company is an...