The position provides shared responsibility for the daily operations, activities and projects for the Case Management Department. This position will work under the general direction of the Director of Case Management and in partnership with the other department managers to provide performance management and development of the case management staff and projects associated with the department to ensure compliance with department policies and procedures along with the implementation of assigned projects. This position may require attendance at joint operational meetings. The incumbent is responsible for monitoring of case management reports and reporting to management or committees.
POSITION RESPONSIBILITIES:
- Hires, manages, trains, reviews, and sets goals for department and staff.
- Works with the Director in the development, implementation and evaluation of the department’s case management policies and procedures.
- Ensures programs, policies and procedures are aligned with CMS, DHCS and NCQA standards.
- Collects, analyzes and responds to data regarding overall and individual case management effectiveness.
- Develops and implements complex project plans for current or new programs which will assist with improving efficiencies, outcomes and satisfaction according to federal and/or state regulations.
- Develops and maintains relationships with providers, networks and groups in order to serve as a liaison between the Health Plan and the provider.
- Forwards cases requiring Director or Medical Director review or intervention and route appropriately.
- Work in partnership with the other Case Management managers to meet all project deadlines.
- Other projects and duties as assigned.
Required Skills
- Maintain and ensure confidentiality of patient information.
- Communicate in both written and verbal formats.
- Think analytically to evaluate potential courses of action.
- Develop creative/innovative approaches to challenges and opportunities.
- Utilize and access computer programs – both Microsoft Office applications and job-specific applications like Facets and Guiding Care.
- Think independently and disagree constructively with peers and bosses.
- Document and manage process for projects.
- Effectively engage and lead a team of more than 20 employees or smaller teams of less than 5 toward a common goal or set of goals.
Required Experience
EXPERIENCE & EDUCATION:
- Bachelor’s degree in public health, health care, or related field; or equivalent work experience is required. Master’s degree preferred.
- Active and unrestricted RN license or LCSW license to practice in the State of California required.
- 5 + years of managed care experience required.
- 5+ years of management level experience required.
- Active CCM certification preferred.
KNOWLEDGE OF:
- National Committee for Quality Assurance (NCQA) QI 5 Standards; complex case management.
- Principles and practices of managed health care.
- Appropriate strategies to serve diverse populations.
- Principles of effective supervision, team leadership, and staff engagement.
Grade: O
#LI-POST
#Indeed