Clinical Manager, RN
About The Position
Empowering Wellness, Transforming Lives Optima Medical Management Group is dedicated to enhancing the quality of life by promoting wellness. At Optima MMG and all of its divisions: Serene Health, Community Support, and American TrueCare, our mission is to provide comprehensive support and care that not only addresses immediate concerns but also fosters long-term well-being. As pioneers in the field, we aspire to lead in member care outcomes and set new standards for excellence and innovation. We are committed to empowering our members to achieve self-sufficiency in health, creating a ripple effect that strengthens families and communities. Our work culture at Optima MMG is built on pride, passion, and a collective commitment to making a positive difference in people's lives. Our team members are dedicated problem-solvers who bring their unique skills and perspectives to the table. We believe that by fostering a collaborative and supportive environment, we can unlock the full potential of our team and, in turn, provide the best possible care to our members. A career at Optima MMG is an opportunity to be part of a dynamic and forward-thinking organization. We encourage continuous learning and professional growth, providing our employees with access to industry experts, cutting-edge technologies, and a supportive community that values each individual's contributions. Join us on this journey to not only advance your career but to be a driving force in transforming lives and communities through passionate and fulfilling work!
Requirements
- Active, unrestricted California RN license.
- Bachelor s in science of nursing; MSN preferred.
- Minimum 5 years of clinical nursing experience, including at least 2 years in a supervisory or management role.
- Experience working with Medi-Cal and/or managed care populations.
- Strong clinical judgment, leadership, and communication skills.
- Ability to work independently and collaboratively.
- Ability to work on-site at our San Diego office.
Nice To Haves
- Bilingual English/Spanish.
- Case management or utilization management experience.
- Familiarity with Enhanced Care Management (ECM) or Health Home programs.
- Experience leading audits or regulatory reviews.
- Training in Motivational Interviewing or trauma-informed care.
Responsibilities
- Supervise, mentor, and evaluate RN Clinical Case Managers and provide clinical direction to ECM Lead Care Managers.
- Manage staffing, scheduling, caseload assignments, and workflow distribution to meet program and productivity targets.
- Support recruitment, onboarding, and ongoing training of clinical and care management staff.
- Conduct performance reviews, coaching, and corrective action in partnership with Human Resources.
- Foster a collaborative, accountable, and member-centered team culture.
- Serve as the senior clinical resource for escalations, complex cases, and clinical decision-making.
- Oversee clinical department data, workflows and employee metrics, and report those to leadership as required.
- Review and clinically approve individualized ECM care plans; ensure plans are updated with changes in clinical status or utilization.
- Identify and monitor clinical and utilization risks impacting member outcomes.
- Oversee medication review processes for safety concerns, adherence issues, and escalation needs.
- Collaborate with primary care providers, behavioral health clinicians, and internal care teams.
- Oversee clinical staff, approve time cards and time requests.
- Provide feedback, evaluations, and progressive discipline as necessary to promote a fully functioning clinical team.
- Oversee transitions of care following emergency department visits, hospitalizations, or other significant events.
- Oversee the clinical triage chat line, answer and document member interactions from that workflow as necessary.
- Oversee the New enrollment call line and workflow, ensuring timeliness, accuracy and clinical integrity of ICP creation and data entry.
- Ensure care plans and clinical documentation meet Medi-Cal, CalAIM, and ECM program requirements.
- Lead and support audits, chart reviews, and quality improvement initiatives.
- Develop and refine clinical workflows, policies, tools, and best practices.
- Provide clinical education and consultation to ECM staff.
- Ensure timely, accurate, and compliant clinical documentation across the team.
- Oversee internal reporting on member outcomes, utilization, care plan progress, and team performance.
- Performs other duties as assigned.
Benefits
- Medical, Dental, & Vision Benefits
- Short & Long-Term Disability Benefits
- Voluntary Accident, Voluntary Critical Illness, and Voluntary Hospital Indemnity Plans
- Flexible Spending Accounts
- Employee Assistance Program (EAP)
- 401(K)
- Paid Vacation and Sick Leave
- Paid Holidays
- Employee Referral Program
- Company Discount Program
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What This Job Offers
Job Type
Full-time
Career Level
Manager
