Duties: The Care Management Specialist is primarily responsible for the overall coordination of the Direct Lines of Business programs for the company's health plan members. Responsibilities include program development, technology implementation and integrity, ensuring regulatory and accreditation compliance, program utilization and outcome reporting. The position is also responsible for assuring all functions are operating in accordance with the organization's mission, values and strategic goals; are focused on continuous improvement and provided in a manner that is responsive and culturally sensitive to the needs of the company's diverse membership. In collaboration with the Primary Care Provider (PCP) and other treatment professionals, performs telephonic physical, functional and psycho-social assessments, assesses readiness to change, develops and maintains a member/family specific individualized care plan developed using evidenced based guidelines, approved clinical practice guidelines or protocols to determine variance from expected outcomes, linking member/family to resources within and outside the health care system and community, and researches all potential resources if gaps exist for that member within their service continuum, continuously maintaining an advocacy position. The Care Management Specialist may also provide back-up care management support for the other direct lines of business and CCS members as needed. Qualifications: Required: Bachelor's Degree in Nursing or , Health Administration, Public Health or related healthcare field. Current, active, unrestricted California Registered Nurse license Previous management experience Utilization Management/Case Management experience - 5 years HMO managed care with prior experience in ambulatory case management, disease management or any combination of education/experience which would provide an equivalent background strong clinical skills with a knowledge of behavioral assessment techniques knowledge of health and/or patient education and behavioral change techniques proficiency with Microsoft Office (Excel, Word, Access, etc) excellent interpersonal and communication skills good working knowledge of regulatory requirements/standards computer literacy and adaptability to computer learning time management and priority-setting skills Previous experience in a health plan developing and performing UM case management/disease management Experience working with the Midi-Cal and Medicare populations Preferred: Master's Degree in Nursing, Health Administration, Public Health or related healthcare field. Bilingual in one the following languages: English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese, Korean Case Management Certification; Public Health Nursing certification; Certified About Aerotek: Aerotek, headquartered in Hanover, Md., is a leading provider of technical, professional and industrial staffing services. Established in 1983, Aerotek is an operating company of Allegis Group, the largest provider of staffing services in the U.S. Aerotek operates a network of more than 200 non-franchised offices throughout the U.S., Canada and Europe. For more information, visit aerotek.com. Aerotek is acting as an Employment Agency in relation to this vacancy. ()
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