ABOUT US: We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve over 350,000 members in Santa Cruz, Monterey and Merced counties. To learn more about us, click here or check out this video.
WHAT YOU'LL BE RESPONSIBLE FOR Developing and managing an individualized intervention plan for members referred into the Care Management program with the goal of promoting optimal, achievable outcomes in the most cost effective and appropriate manner. You will work in conjunction with the interdisciplinary Care Management team to facilitate quality outcomes across the continuum by educating members, providers, external agencies, and internal departments and providing assistance in navigating the managed care system. You will participate in Quality Improvement efforts, to continually evaluate the Care Management Program’s effectiveness and its quality driven, cost effective achievable goals and outcomes for Alliance members.
ABOUT THE TEAM This is a new team forming in the Care Management Department as we, the Alliance, a Medi-Cal managed care plan, implement the Whole-Child Model (WCM), and incorporate California Children’s Services (CCS) covered services into our plan. CCS is a statewide program for children with special health care needs. The CCS services were previously “carved out” (not a covered benefit of our plan) and were coordinated by the respective counties in our contracted areas. We are working with each county in preparation for our July 1, 2018 implementation date to assume responsibility for payment, authorization and care coordination of primary and specialty services for CCS-eligible children and youth. To learn more about the WCH model, integration of CCS services and other resources, click here.
THE IDEAL CANDIDATE • Be excited about being a part of something new for the health plan, and acknowledge the challenge and opportunity that this time presents • Learn from our County partners as we implement this program, with a goal of a seamless transition for the families as we target our July 1st effective date • Be motivated to serve children with special health care needs and partner with their families while able to maintain professional boundaries in relationships that could be built from the time a member is in the NICU to the time they are 21 • Be flexible in a changing and dynamic environment, and appreciate that each day will be a bit different • Be comfortable spending time on-site with the County during training and onboarding and then translating the knowledge and information back to us
WHAT YOU'LL NEED TO BE SUCCESSFUL • Knowledge of: - The principles and practices of case management including assessment, care/treatment planning, discharge planning and documentation - Medi-Cal and related policies and regulations - The principles and practices of health care, medical administration and health care systems, including managed care • Ability to: - Use pro-active customer service skills in handling complex and demanding situations - Advocate on behalf of the individual to assure quality of care and attainment of appropriate goals - Create, document, and implement intervention plans - Manage person who are non-compliant and or have behavioral health issues • Education and Experience: - Master’s degree in Social Work or similar field of study - Two years of Social Service experience in an acute care setting, community agency or managed care environment or an equivalent combination of education and experience which would provide the required knowledge, skills and abilities may be qualifying
OUR BENEFITS: • Medical, Dental and Vision Plans • Ample Paid Time Off • 11 Paid Holidays per year • 401(a) Retirement Plan • 457 Deferred Compensation Plan • Robust Health and Wellness Program • Fresh Fruit Delivery • EV Charging Stations • And many more!
Applicants must be currently authorized to work in the United States on a full-time basis.
Internal Number: 36145
About Central California Alliance for Health
The Alliance is an award-winning regional non-profit health plan, established in 1996, with over 19 years of successful operation. Using the State’s County Organized Health System (COHS) model, we currently serve 328,486 members in Santa Cruz, Monterey and Merced counties. We work in partnership with our contracted providers to promote prevention, early detection and effective treatment, and improve access to quality health care for those we serve. This results in the delivery of innovative community-based health care services, better medical outcomes and cost savings. The Alliance is governed with local representation from each county on our Board of Commissioners.