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LaSalle Medical Associates is seeking a passionate and highly qualified Licensed Vocational Nurse (LVN) with experience in the California Children's Services (CCS) program to join our team. We are committed to the success of our professionals and the families we serve through the CCS program.
As the Special Programs CCS Manager, your primary responsibility is to review outpatient and inpatient authorizations for members under 21 years of age to determine their eligibility for the CCS program. This role requires you to integrate your clinical knowledge with medical guidelines to assess and evaluate a member’s participation in the program.
Your duties will include:
● Interpreting Service Authorization Requests (SARs) and Notices of Action (NOAs).
● Critically examining patient medical records to ensure they meet CCS criteria.
● Assessing the severity of illnesses, intensity of services, and coordinating care.
● Managing all activities related to monitoring, interpreting, and appealing CCS approvals and denials.
● Working with a multidisciplinary team to improve documentation and identify potential appeals.
● Preparing and conducting detailed training with the provider network.
● Participating in meetings and provider training sessions, which may require travel across California.
● Completing monthly CCS health plan logs and other assigned duties.
● Creating, managing, and updating Excel spreadsheets to track the authorization process.
● Conducting complex research and analysis to improve program processes and achieve goals.
● Valid California Licensed Vocational Nurse (LVN) license is required.
● Minimum of 1 year of Utilization Management experience is required.
● Minimum of 1 year of California Children's Services (CCS) experience is preferred.
● High School Diploma or equivalent is required.
● Bachelor’s degree in Health Care Administration or a related field is preferred.
● This is an on-site position located in Fresno, CA.
● Travel required to provider offices across the Central Valley, off-site meetings and other travel as assigned.
● Phone/video, zoom contact with management, providers, health plans and vendors.
● This position has no direct reports.
LaSalle Medical Associates IPA