Care Manager

Community Health Plan of Imperial Valley•Imperial, CA

15d•$85,000 - $125,000

About The Position

Community Health Plan of Imperial Valley (CHPIV), Imperial County’s Medi-Cal managed care plan, is hiring a Care Manager to lead a team of Care Coordinators responsible for case management, health management, and transitions of care that support members’ healthcare needs. The role provides guidance to the care coordination team, manages caseload allocation according to medical and psychosocial complexity, and helps ensure services align with the plan’s model of care and applicable regulatory requirements. The Care Manager maintains compliant electronic case management documentation, audits assessments and care plans for completeness and timeliness, monitors transition-of-care assessments and outreach timelines, and participates in internal and external audits. The role also supports multidisciplinary collaboration, provider outreach, family and caregiver engagement, resource coordination, and the development of business requirement documents and user training materials. The position may be remote for candidates residing in California; preference is given to candidates local to Imperial, California.

Requirements

Active California Registered Nurse license without restriction.
At least 3 years of experience leading Care Coordinators.
At least 3 years in management, case management, disease management, or managed care in medical or behavioral health settings.
Knowledge of managed care principles and practices, with emphasis on Care Management and/or Care Coordination.
Clinical knowledge and critical-thinking skills to assess individualized whole-person care needs and develop effective care plans.
Working knowledge of and ability to efficiently use applicable computer software, including Outlook, Word, Excel, and specific case management programs.
Experience partnering with multiple members of a healthcare team, internally and externally.

Nice To Haves

Preference for candidates local to Imperial, California; remote candidates living in California will also be considered.

Responsibilities

Provide direction and guidance to Care Coordinators to ensure activities align with the model of care and meet regulatory requirements.
Manage team caseloads appropriately based on the complexity of members’ medical or psychosocial needs.
Maintain the electronic case management documentation system in compliance with standard processes, documentation styles, and HIPAA.
Complete required training and implement changes.
Promote multidisciplinary collaboration, provider outreach, and engagement of families and caregivers to enhance continuity of care.
Audit case management assessments and care plan development for completeness and timeliness according to state requirements.
Monitor the completeness of Transition of Care (TOC) assessments and contact timeframes under TOC protocols.
Participate in required internal and external audits, either remotely or onsite.
Create business requirement documents, user training materials, and related documentation.
Assist with care coordination to connect members with appropriate resources and services.