Lead Case Manager-RN-ACO/ CCM

Clinica Sierra Vista•Bakersfield, CA

About The Position

The Lead Case Manager for value-based programs such as Chronic Care Management (CCM) and ACO services (for patients enrolled in Medicare) is responsible for coordinating with external CCM and ACO supervisors and programs, serving Fresno and Kern County. This role involves managing day-to-day activities, ensuring the efficient use of resources, and maintaining high performance standards while meeting the Centers for Medicare and Medicaid Services (CMS) program requirements. The Lead Case Manager will work closely with leadership, care teams, and external partners to drive team performance, ensure compliance, and contribute to achieving programmatic goals aligned with Centers for Medicare and Medicaid Services (CMS) initiatives.

Requirements

Education: Graduation from an accredited School of Registered Nursing.
Experience: 5 years of experience in a managerial or supervisory role, preferably Clinica Sierra Vista or Medi-Cal program setting.
Strong leadership, organizational, and communication skills.
Ability to motivate and manage a multidisciplinary team.
Excellent problem-solving and decision-making capabilities.

Responsibilities

Work with the CAO and other department directors to ensure compliance with agency, grant, and regulatory requirements, including OSHA, ADA, CLIA, HIPAA, HRSA, TJC, NCQA, DHCS, FQHC and all CMS specific standards
Report and address any legal, privacy, safety, or risk management issues related to CCM and ACO services.
Track and evaluate CCM and ACO program successes through data-driven decision-making, patient engagement, and quality assurance reviews.
Oversee CCM staff access, including client service specialists, medical assistants, case managers, and outreach workers, ensuring compliance with CCM and ACO program guidelines.
Monitor staff schedules and PTO requests to always ensure adequate coverage. (If applicable)
Ensure timely submission of staff payroll and accounting records to facilitate prompt payroll processing. (If applicable)
Perform introductory and annual employee reviews and competency assessments, and provide constructive feedback to support organizational and professional growth. (If applicable)
Address patient needs, including complaints, problem-solving, and de-escalation, ensuring timely resolution per CSV policies.
Represent Clinica Sierra Vista’s Value Based Programs or partnerships such as CCM.
Deliver presentations to promote public awareness of CCM and ACO services and eligibility criteria.
Manage in basket message from external partners.
Provide guidance and support to CCM and ACO program staff to ensure quality patient care, customer service, and coordination of care for internal and external clients. This includes providing access to CSV resources as needed.
Analyze and improve key quality indicators to prioritize, organize, and coordinate strategies for CCM and ACO program growth, marketing, and patient engagement.
Assess processes and workflows to ensure efficient and client-centered CCM and ACO program care delivery.
Identify, track, and report organizational and performance improvement activities within the CCM and ACO services framework.
Ensure staff adherence to Clinica Sierra Vista policies and CCM and ACO specific procedures while proactively addressing compliance issues.
Collaborate with discipline-specific supervisors for clinical performance management. Set, model, and reinforce clear expectations, foster open communication, and provide problem-solving support.