Overview

The Manager of Care Coordination (CC) will lead and support the department leadership in thedevelopment, implementation and evaluation of Partnership’s clinical case management services.Collaborates with Supervisor(s) to oversee the department activities and provides guidance tomanage these functions to enhance cost effectiveness, ensure compliance with applicable state andfederal regulations, and to fulfill all contractual requirements.

Responsibilities

• Provides day-to-day direction to CC Supervisors, and licensed and non-licensed CC staff to meet department goals and objectives and to ensure compliance with company policies.Tracks, monitors, manages and distributes work and assignments to appropriate CC staffin accordance with job descriptions, practice level, and business needs.
• Works closely with Health Services leadership to develop meaningful performance measures to determine the quality, effectiveness, and efficiency of department operations in achieving desired outcomes.
• Assists in survey-readiness activities to ensure the department is compliant with all applicable regulations, licensure requirements, accreditation standards (i.e. NCQA), and new legislation.
• Provides administrative, technical, and clinical management of assigned staff in accordance with industry best practices which includes training oversight, the responsibility for hiring, performance evaluation, performance improvement, education, staff development, work allocation and problem resolution.
• Performs random auditing and review of all case management activities to ensure DHCS compliance standards are achieved. Provides a summary of findings to Health Servicesleadership as requested.
• Provides direction and oversight to ensure efficient and appropriate collaboration between the CC staff and the delegated mental health provider and other internal and external organizations.
• Provides oversight of training program to ensure adequate training accomplishes objectives and results in staff competency.
• Works with other departments to resolve claims, grievance, UM, QI, RAC and member issues as necessary.
• Develops structures, relationships, and processes to promote active partnerships with providers, community stakeholders, and/or other healthcare professionals to meet and support key organizational initiatives (ex: MOU requirements, CalAIM, etc.)
• Ensures compliance with all departmental and organizational policy and procedures; develops and works with leadership to implement standardize processes to achieve efficient operations for the provision of optimal patient care.
• Reviews appropriate scope of practice by staff. Ensures that all team members are familiar with prominent professional standards especially related to issues such as confidentiality, informed consent, conflicts of interest, dual relationships, boundary issues, documentation, consultation, etc.
• Participates in all audits or surveys as requested by preparing documentation or reports as needed.
• Communicates activities and promotes continuous process improvement to ensure activities are appropriately managed with other departments and providers both within and outside the organization.
• Participates in and provides leadership in identifying, developing and advancing departmental goals to further organizational goals and mission.
• Reviews and participates in operationalizing newly released All Plan Letters (APL)
• Provides yearly update and review of CC designated Policies and Procedures
• Identifies opportunities for improvement in Care Coordination workflow processes to ensure high quality case management services are delivered
• Participates in process improvement projects to improve Case Management programs as needed
• Performs Human Resource functions such as time card management, directing work activities, implementing workplace changes, conducting annual reviews, and conducting staff trainings.
• Serves as a role model and resource to colleagues, staff, members, and others across assigned regional offices.
• Leads the interview process for other staff within the department.
• Maintains clear and appropriate employee performance files for direct reports, and mentors supervisory staff in this area
• Holds individual staff meetings designed to identify performance level and assist with career growth and progression for assigned direct reports.
• Other duties as assigned.

Qualifications

Education and Experience

Bachelors of Science in Nursing preferred; minimum five (5) yearsacute care experience, two (2) years managed care experience; orequivalent combination of education and experience. Minimum one (1)year prior experience in a leadership or management role.

Special Skills, Licenses and Certifications

Current California Registered Nurse License. Certifications in chosenfield such as advance practice nursing or case management. Strongknowledge of nursing standards in both inpatient and outpatientsettings. Strongly leadership, program evaluation and managementskills. Thorough knowledge of Care Coordination, Discharge Planning,Case Management and Utilization Review within a managed careenvironment. Familiarity of business practices and protocols accessingdata sets and information using automated systems. Ability to workwithin an interdisciplinary structure and function independently in afast-paced environment while managing multiple priorities anddeadlines. Strong organizational skills required. Computer literacy andproficiency. Valid California Driver's License and proof of currentautomobile insurance compliant with Partnership’s policies arerequired to operate a vehicle and travel for company business.

Performance Based Competencies

Excellent written and verbal communication skills in English.Demonstrated experience and ability to build effective workingrelationships and to represent the department effectively in order toaccomplish goals. Ability to manage multiple concurrent projects andmaintain a work pace appropriate to the workload. Ability to assistindividuals in recognizing and solving problems. Ability to supervise,train, motivate, provide guidance to staff

Work Environment And Physical Demands

Ability to use a computer keyboard. Ability to prioritize workload andinitiate action to acquire needed information from professionals byphone. Ability to function effectively with frequent interruptions anddirection from multiple team members. More than 50% of work time isspent in front of a computer monitor. Must be able to lift, move, or carry objects of varying size, weighing up to 10 lbs. Some travel required (up to 25%) including occasional overnight.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$ 120,686.00 - $ 156,735.06

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.