Manager, Care Management

SCAN Health Insurance•Long Beach, CA

1d•$92,400 - $133,671•Remote

About The Position

Manages the daily operations and continuous quality improvement of care management programs at SCAN to ensure the delivery of high quality, evidence-based care with a focus on addressing the medical, behavioral health, and social needs of members. The goal is to oversee teams and programs that help achieve excellent health and support provider and member engagement. Provides leadership and oversight across multiple care management pods through direct management of care management supervisors, ensuring operational excellence, workforce optimization, quality outcomes, compliance, and achievement of departmental objectives.

Requirements

Bachelor's Degree or equivalent experience.
Bachelor's Degree in Healthcare Administration, Nursing, Social Work, Public Health, Business Administration, or related field, or equivalent combination of education and experience.
3+ years of progressive leadership experience in complex healthcare operations, care management, care coordination, population health, or integrated care delivery programs, including supervisory or management responsibilities.
Leadership - Lead and inspire teams to achieve
Problem Solving - Good problem-solving skills
Communication - Good communication and interpersonal skills
Strong written and oral communication skills, as well as strong interpersonal, critical thinking, and analytical skills.
Demonstrated ability to work with all levels of staff, within and external to the organization to achieve goals.
Ability to prioritize multiple and competing tasks.
Ability to work independently or as a team while working in a fast-paced and dynamic environment.
Basic knowledge of related NCQA standards, CMS and DHCS regulations.
Medical and clinical terminology conversant.
Leading through subordinate leaders.

Nice To Haves

Graduate or Advanced Degree or equivalent experience.
Active clinical-related licensure (e.g., RN, LCSW, LMFT or equivalent) preferred.
Medicare/Medi-Cal experience in managed care environment.
Experience leading care management, care coordination, population health, or healthcare operations programs in a medical group, IPA, HMO, health plan, or integrated delivery system preferred.
Experience leading through subordinate leaders and coordinating diverse teams to achieve organizational goals preferred.
Bilingual ability strongly preferred.
Curious about AI and its power to transform how we operate and serve our members.

Responsibilities

Provides oversight of care management teams and supervisor-led care management pods to drive operational excellence and productivity and to ensure the achievement of department goals and objectives.
Provides guidance and support with urgent and escalated issues.
Accomplishes results by communicating to staff job expectations; planning, monitoring, and appraising job results; coaching and counseling employees; initiating, coordinating, and enforcing systems, policies, and procedures.
Maintains staff by recruiting, selecting, orienting, and training employees; maintaining a safe and secure work environment; developing personal growth opportunities.
Directly manages care management supervisors and provides leadership, coaching, performance management, mentorship, and accountability for pod performance.
Participates in establishing strategic plans and objectives; collecting and monitoring performance; developing dashboards and reports; and developing and evaluating programs and projects that promote health, improve member engagement, and address holistic member needs.
Ensures that department policies and procedures, desktop procedures, workflows, job aides, training materials, are current and accurately reflect processes in order to provide consistent quality care in compliance with department requirements.
Collaborates with internal departments to ensure seamless care and support clinical and operational goals and create and review department metric reporting.
Facilitates staff meetings and interdisciplinary team meetings.
Builds effective professional relationships with providers and other internal and external partners utilizing verbal and written communication skills, developing trust, meeting timelines, respecting cultural differences, using active listening skills, and maintaining confidentiality.
Serves as a subject matter expert and represents the department at assigned committees to support two-way communication between department and committee and committee to department head and/or staff as appropriate.
Promotes process improvement, quality assurance, and compliance with and adheres to all regulatory and quality standards including but not limited to: Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and accreditation bodies’ standards such as the National Committee for Quality Assurance (NCQA) as it relates to Complex Care Management activities.
Consults with SCAN Medical Directors and other clinical subject matter experts when needed regarding complex medical and behavioral health situations and facilitates appropriate coordination with the care team.
Maintains the member‘s right to privacy and protects SCAN operations by keeping information confidential.
Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, participating in professional societies.
Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.)
Actively support the achievement of SCAN’s Vision and Goals.
Other duties as assigned.