Partnership HealthPlan of California · 2 weeks ago
Manager of Care Coordination
US-CA-Auburn
Full-time
Onsite
Mid, Senior Level
$136K/yr - $177K/yr
5+ years expPartnership HealthPlan of California is seeking a Manager of Care Coordination to lead and support the department in the development and evaluation of clinical case management services. The role involves overseeing department activities, ensuring compliance with regulations, and enhancing cost-effectiveness while collaborating with various stakeholders.
Health CareInsuranceNon Profit
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 staff in 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 Services leadership 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
Qualification
Required
Minimum five (5) years acute care experience
Two (2) years managed care experience
Equivalent combination of education and experience
Minimum one (1) year prior experience in a leadership or management role
Current California Registered Nurse License
Strong knowledge of nursing standards in both inpatient and outpatient settings
Strong leadership, program evaluation and management skills
Thorough knowledge of Care Coordination, Discharge Planning, Case Management and Utilization Review within a managed care environment
Familiarity of business practices and protocols accessing data sets and information using automated systems
Ability to work within an interdisciplinary structure and function independently in a fast-paced environment while managing multiple priorities and deadlines
Strong organizational skills required
Computer literacy and proficiency
Valid California Driver's License and proof of current automobile insurance compliant with Partnership's policies are required to operate a vehicle and travel for company business
Excellent written and verbal communication skills in English
Demonstrated experience and ability to build effective working relationships and to represent the department effectively in order to accomplish goals
Ability to manage multiple concurrent projects and maintain a work pace appropriate to the workload
Ability to assist individuals in recognizing and solving problems
Ability to supervise, train, motivate, provide guidance to staff
Ability to use a computer keyboard
Ability to prioritize workload and initiate action to acquire needed information from professionals by phone
Ability to function effectively with frequent interruptions and direction from multiple team members
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
Preferred
Bachelors of Science in Nursing preferred
Certifications in chosen field such as advance practice nursing or case management
Company
Partnership HealthPlan of California
Partnership HealthPlan of California is a non-profit community-based health care organization that contracts with the state to administer Medi-Cal benefits through local care providers to ensure Medi-Cal recipients have access to high-quality comprehensive cost-effective health care.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
L
Lorna Veloso
Sr. Manager of OpEx/PMO
Recent News
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