Care Management Program Manager - Community Coordination
Central California Alliance for Health
August 22, 2018
Scotts Valley, California
Full Time - Experienced
Care Management Program Manager - Community Coordination Scotts Valley, CA
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 approximately 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 Managing day-to-day operations related to Alliance oversight of community-based care management programs, including Intensive Case Management and the Health Homes Program. You will serve as the primary liaison for coordination between the Care Management (CM) Department and community-based care management programs, support clinical practice oversight, research, and operational processes based on Medi-Cal and Knox-Keene requirements and will perform clinical audits to ensure compliance with requirements.
ABOUT THE TEAM This position is in the Care Management (CM) Department, which is responsible for the coordination of resources for members with complex needs. Our department is made of up Nurses, Care Coordinators, Social Workers, Registered Dietitians and Health Educators. Our team is collaborative, committed and fun. We work hard, promote learning and encourage each other’s strengths in a professional and supportive work environment.
THE IDEAL CANDIDATE WILL HAVE • A Master’s degree in a related field • Certification by a nationally recognized case/care management organization • PHN certification • Experience working with community-based care management programs • Program development and program management experience
WHAT YOU'LL NEED TO BE SUCCESSFUL Knowledge of: • Principles and practices of clinical research and assessment • Principles and practices of case management and the array of case management services • Principles and practices of managed care and/or utilization management • Research, analysis, and reporting tools and methods • Relevant healthcare regulatory and accreditation requirements, including Medi-Cal, Knox-Keene and National Committee for Quality Assurance (NCQA) • Windows based PC systems and Microsoft Word, Excel, PowerPoint and Outlook • Tools and techniques related to program and project management Ability to: • Audit, analyze and assess medical records and other health care data • Utilize evidence based practice guidelines in the evaluation and management of care management and transitional care activities • Develop and implement projects, systems, programs, policies and procedures • Act as a technical resource and explain regulations, processes, and programs related to area of assignment • Provide leadership and facilitate meetings • Foster effective and collaborative working relationships, influence others, and build consensus with individuals at all levels in the organization • Recognize and effectively utilize the most appropriate mode of communication based upon the circumstances of the situation • Professionally direct and manage difficult callers or other types of challenging interactions through the utilization of interpersonal intervention skills Education and Experience: • Current and unrestricted license as a Registered Nurse and a Bachelor’s degree in Nursing or current and unrestricted license as a Licensed Clinical Social Worker • Three years of case management experience or an equivalent combination of education and experience, which would provide the required knowledge, skills and abilities may be qualifying
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: 54080
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.