Santa Clara Family Health Plan (SCFHP) is a local, community-based health plan dedicated to improving the health and well-being of the residents of Santa Clara County. SCFHP's mission is to provide high quality, comprehensive healthcare coverage for those who do not have access to, or are not able to purchase, good healthcare at an affordable price.
Responsibilities for a Supervisor, Case Management
Develop, implement and supervise case management workflows in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures and business requirements for all lines of business.
Monitor and provide continuous quality improvement to the processes of basic, specialty and complex case management, including timely completion of Health Risk Assessments (HRA), documented development of member care teams, development and monitoring of Individual Care Plans (ICP) and changes to members’ risk stratification after time of enrollment.
Collaborate with the Manager of Case Management with routine and ad hoc audits and the development, implementation and monitoring of corrective action plans.
Ensure the integration of Case Management operations into other internal and external teams/departments including Long Term Services and Supports and Behavioral Health.
Collaborate with the Manager of Case Management with the oversight and assignment of RN Case Manager, Medical Management Coordinator and Personal Care Coordinator caseloads across various case management programs.
Resolve or facilitate resolution of problematic and/or complex issues by escalating to appropriate management/leadership person.
Establish and maintain effective interpersonal relationships with staff at all levels, members and/or their authorized representatives, providers, other program or agency representatives.
Carries out supervisory/management responsibilities in accordance with the organization’s policies, procedures, applicable regulations and laws.
Recruiting, interviewing, and hiring.
Developing a high performing department culture and staff. This includes setting the standard for staff/peers and motivating employees to maximize organizational goals and objectives.
Setting goals and planning, assigning and directing work consistent with said goals. This includes responding to employees’ needs, ensuring they have the necessary resources to do their work.
Appraising performance, rewarding and disciplining employees, addressing complaints and resolving issues. This includes providing regular and effective feedback to employees and completing timely and objective performance reviews.
Qualifications for a Supervisor, Case Management
Unrestricted professional clinical licensure in state of California.
Minimum two years of progressively responsible experience in a supervisory or lead capacity in case management, utilization management, discharge planning and/or quality improvement in a managed care setting.
Current working knowledge of Medicare and/or MediCal regulations and NCQA Population Health standards.
Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events.
Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs.
Ability to use a keyboard with moderate speed and high level of accuracy.
Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing.
Benefits for a Supervisor, Case Management
medical/vision, dental, life, retirement plans (CalPERS, 401a with employer match, and 457),
PTO (23 days a year)
About Santa Clara Family Health Plan
Santa Clara Family Health Plan (SCFHP) is a local, public, not-for-profit health plan dedicated to improving the health and well-being of the residents of Santa Clara County. Our mission is to provide high quality, comprehensive health care coverage for those who do not have access to, or are not able to purchase, good health care at an affordable price. Working in partnership with select providers, we act as a bridge between the health care system and those who need coverage.
We do this by offering comprehensive, affordable medical, dental and vision coverage through our health insurance programs: Medi-Cal, Healthy Kids, and Cal MediConnect (Medi-Cal is a public insurance program and Healthy Kids is a locally funded insurance program).
Since 1997, SCFHP has partnered with providers to deliver high quality health care to its members. Through dedication to integrity, outstanding service, and care for the community, SCFHP works to ensure that everyone in the county receives the care they need for themselves and for their families. SCFHP currently serve over 270,000 residents of Santa Clara County.
We are hiring! We offer competitive salaries and a comprehensive benefits pac...kage including PTO, holidays, fitness center membership, medical, dental, and vision coverage, CalPERS retirement, 401a and 457 Deferred Compensation retirement plans. Visit our website for current openings.
Medi-Cal, Healthy Kids, and Cal MediConnect