Manager of Care Coordination

Partnership HealthPlan of California•Fairfield, CA

1d•$141,067 - $183,387

About The Position

The Manager of Care Coordination leads and supports department leadership in developing, implementing, and evaluating clinical case management services. In collaboration with supervisors, the manager oversees department activities and guides work to enhance cost effectiveness, comply with applicable state and federal regulations, and fulfill contractual requirements. The position provides day-to-day direction and administrative, technical, and clinical management for Care Coordination staff, while advancing department and organizational goals and supporting high-quality case management services. The manager works with Health Services leadership and other departments, providers, and external organizations to monitor performance, maintain survey readiness, resolve operational issues, improve processes, and ensure compliance with relevant standards and requirements. The role also oversees staff training and development, performance management, work allocation, and supervisory functions. Some travel is required, including occasional overnight travel.

Requirements

Bachelor of Science in Nursing preferred; a minimum of five years of acute care experience and two years of managed care experience, or an equivalent combination of education and experience.
At least one year of prior leadership or management experience.
Current California Registered Nurse license.
Strong knowledge of nursing standards in inpatient and outpatient settings.
Strong leadership, program evaluation, and management skills.
Thorough knowledge of Care Coordination, discharge planning, case management, and utilization review in a managed care environment.
Familiarity with business practices and protocols for accessing data sets and information using automated systems.
Ability to work in an interdisciplinary structure and independently in a fast-paced environment while managing multiple priorities and deadlines.
Strong organizational skills, computer literacy, and proficiency.
Valid California driver's license and proof of current automobile insurance compliant with Partnership policies to operate a vehicle and travel for company business.
Excellent written and verbal communication skills in English.
Ability to build effective working relationships and represent the department effectively to accomplish goals.
Ability to manage multiple concurrent projects and maintain a work pace appropriate to the workload.
Ability to assist individuals in recognizing and solving problems, and to supervise, train, motivate, and guide staff.
Ability to use a computer keyboard, prioritize workload, and initiate action to obtain needed information from professionals by phone.
Ability to function effectively with frequent interruptions and direction from multiple team members.
Ability to lift, move, or carry objects weighing up to 10 pounds.

Nice To Haves

Bachelor of Science in Nursing.
Certifications in the chosen field, such as advanced practice nursing or case management.

Responsibilities

Provide day-to-day direction to Care Coordination supervisors and licensed and non-licensed staff, distribute work and assignments, and support achievement of department goals and compliance with company policies.
Work with Health Services leadership to develop performance measures for evaluating the quality, effectiveness, and efficiency of department operations and outcomes.
Assist with survey readiness and ensure compliance with regulations, licensure requirements, accreditation standards, and new legislation.
Manage assigned staff, including training oversight, hiring, performance evaluations and improvement, education, staff development, work allocation, and problem resolution.
Conduct random audits and reviews of case management activities for DHCS compliance and summarize findings for Health Services leadership as requested.
Oversee collaboration between Care Coordination staff, the delegated mental health provider, and other internal and external organizations.
Oversee the staff training program to ensure training objectives are met and staff competency is achieved.
Work with other departments to resolve claims, grievance, UM, QI, RAC, and member issues as needed.
Develop partnerships and processes with providers, community stakeholders, and other healthcare professionals to support organizational initiatives, including MOU requirements and CalAIM.
Ensure compliance with departmental and organizational policies and procedures, and work with leadership to implement standardized processes for efficient operations and optimal patient care.
Review staff scope of practice and ensure team members understand relevant professional standards, including confidentiality, informed consent, conflicts of interest, dual relationships, boundaries, documentation, and consultation.
Participate in audits and surveys by preparing requested documentation and reports.
Communicate activities and promote continuous process improvement in coordination with departments and providers inside and outside the organization.
Help identify, develop, and advance departmental goals in support of organizational goals and mission.
Review and help operationalize newly released All Plan Letters (APLs).
Update and review designated Care Coordination policies and procedures yearly.
Identify workflow improvements and participate in projects to improve case management programs.
Perform supervisory functions, including timecard management, directing work, implementing workplace changes, conducting annual reviews, and training staff.
Serve as a role model and resource to colleagues, staff, members, and others across assigned regional offices.
Lead interviews for other staff within the department.
Maintain performance files for direct reports and mentor supervisory staff in this area.
Hold individual meetings with assigned direct reports to assess performance and support career growth and progression.
May serve as the Regional Center Liaison and perform other duties as assigned.