Care Management Manager (Pediatric Case Management), Scotts Valley, CA
Care Management Manager (Pediatric Case Management)
Central California Alliance for Health (the Alliance) is an award-winning regional non-profit Medi-Cal health plan. The Alliance began operating in 1996 and uses the State’s County Organized Health System (COHS) model of Medi-Cal managed care. Our vision is to be a recognized leader in creating local health care solution.
We currently serve over 350,000 members in three counties (Santa Cruz, Monterey and Merced) in Central California. We are a group of over 500 dedicated individuals driven by our mission of providing accessible, quality health care that is guided by local innovation. We are value-based, guided by the following:
- Culture: We strive for a respectful, diverse, professional and fun workplace.
- Customer Service: Our customers’ satisfaction is our highest priority.
- Excellence: We value and continuously improve quality in our services.
- Innovation: We leverage local talent to create solutions.
- Integrity: We tell the truth and do what we say we will do.
- Partnership: We collaborate with others for strong solutions.
- Stewardship: We manage responsibly, and earn the trust of partners and regulators.
We approach health care with innovative methods, and include care management of high utilizers, and social determinants of health in our strategic planning. We strive to develop a regional health care system that delivers quality, high value health care, and we engage actively with our community partners, agencies and stakeholders to share this responsibility.
Under direction, this position manages all aspects of complex case management and care coordination for all adult or all pediatric members, depending upon area of assignment, performs program effectiveness evaluation, manages, supervises, mentors and trains assigned staff, collaborates with a variety of Alliance staff on special projects and performs other duties as assigned.
YOU WILL BRING:
- Working knowledge of:
- The principles and practices of case management
- The tools and techniques related to research, analysis, and reporting
- The principles and practices of supervision and training
- Working knowledge of and proficiency in the use of Windows based PC systems and Microsoft Word, Outlook, PowerPoint and Excel, and Oracle database systems
- Some knowledge of:
- The tools and techniques related to program and project management
- The principles and practices of utilization management
- Medi-Cal and related policy and benefits-related Title 22 regulations
- The concepts and guidelines related to prepaid health care
- The concepts related to managed care
- The principles and practices of statistical analysis
- Ability to:
- Manage, supervise, mentor, train, and evaluate the work of staff
- Organize and prioritize the work of others, delegate effectively, and follow up on work assignments
- Act as a technical resource and explain regulations, processes, and programs related to area of assignment
- Provide leadership and facilitate meetings
- Plan, organize and lead data collection activities
- Present statistical and technical case management data in a clear and understandable manner utilizing appropriate visual aids
- Clearly communicate findings of Care Management reports to providers
- Foster effective working relationships, influence others, and build consensus with individuals at all levels in the organization
- Identify issues, conduct research, gather and analyze information, reach logical and sound conclusions, and make recommendations for action
- Effectively, clearly and independently document, summarize and resolve complex issues
- Work independently and make decisions related to areas of functional responsibility
- Manage the development and implementation of projects, systems, programs, policies and procedures
- Analyze and interpret legal, regulatory and contractual language
- Analyze data and prepare written and oral reports
- Develop training materials, in conjunction with Training and Development staff, and conduct training
- Develop and implement recordkeeping systems and maintain accurate records
- Create forms, correspondence, and other program documents
- Education and Experience:
- Current and unrestricted license as a Registered Nurse issued by the State of California
- Bachelor’s degree in Nursing
- Minimum of five (5) years of experience in a patient care setting, which included a minimum of two (2) years of experience supervising and training clinical staff, one (1) year of case management experience, and some experience in a care management capacity or any combination of education and experience which would provide the required knowledge, skills and abilities may be qualifying.
- (Note: Possession of a current and unrestricted license as Licensed Clinical Social Worker issued by the State of California may substitute for the Registered Nurse license and Bachelor’s degree in Nursing)
- Medical, Dental and Vision Plans
- Generous Paid Time Off
- 11 Paid Holidays per Year
- 401(a) Retirement Plan
- 457 Deferred Compensation Plan
- Tuition Reimbursement
- Costco Membership Reimbursement
- Health and Wellness Program
- Fresh Fruit Delivery
- Electric Vehicle Charging Stations
- And many more!
For a complete position description and to apply online, please visit our careers website at https://ccah-alliance.silkroad.com
If this sounds like an opportunity that you or someone you know may be interested in we invite you to apply! Applicants must be currently authorized to work in the United States on a full-time basis.
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status.