Job ID: 290116581
Last Updated: 9/23/2022
Manager, Case Management
HR Manager (Recruitment)
Accepts J-1 Visas
Manager, Case Management
CalOptima is the single largest health plan in Orange County, serving 880,000 members, or one in four residents. Our motto "Better. Together. is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. If you're looking for an opportunity to work for an organization dedicated to improving local health care and serving the needs of the most vulnerable, we encourage you to join CalOptima.
The Manager, Case Management provides shared responsibility for the daily operations, activities, and projects for the Case Management department. The incumbent works 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. The incumbent may be required to attend joint operational and community meetings. The incumbent is responsible for monitoring of case management reports and reporting to management or committees.
Cultivates and promotes a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short and long-term goals/priorities for the department.
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 Centers for Medicare & Medicaid Services (CMS), Department of Health Care Services (DHCS) and National Committee for Quality Assurance (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 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.
Partners with the other Case Management managers to meet all project deadlines.
Completes other projects and duties as assigned.
Possesses the Ability To:
Maintain and ensure confidentiality of patient information.
Communicate clearly and concisely, both verbally and in writing.
Think analytically to evaluate potential courses of action.
Develop creative/innovative approaches to challenges and opportunities.
Think independently and disagree constructively with peers and bosses.
Document and manage process for projects.
Establish and maintain effective working relationships with CalOptima leadership and staff.
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.
Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems such as Facets and Guiding Care to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Experience & Education:
Bachelor's degree in Healthcare related field, or a current unrestricted Registered Nurse (RN) license to practice in the State of California required.
3 years of experience in Ambulatory Case Management required.
5 years of experience in Managed Care, preferably with Medicare and Medicaid/Medi-Cal populations required.
An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.
For RN's a bachelor's degree in Nursing, Public Health, or other Health Care related field.
For Non-RN's a master's degree in Healthcare, Social Work, or related field.
3 years of supervisory/management level experience.
Active Certified Case Management (CCM) certification.
NCQA Population Health Management (PHM) 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.
Department: Case Management
Reports to: Director, Case Management
FLSA status: Exempt
Salary Grade: P - $117,000 - $181,500
CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations by contacting Human Resources Disability Management at 657-900-1134.
Job Location: Orange, California
To apply, visit https://apptrkr.com/3478490
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