Manager of Care Coordination

Partnership HealthPlan of California•Redding, CA

About The Position

Overview The Manager of Care Coordination (CC) will lead and support the department leadership in the development, implementation and evaluation of Partnership’s clinical case management services. Collaborates with Supervisor(s) to oversee the department activities and provides guidance to manage these functions to enhance cost effectiveness, ensure compliance with applicable state and federal regulations, and to fulfill all contractual requirements. Responsibilities Provides day-to-day direction to CC Supervisors, and licensed and non-licensed CC staff to meet department goals and objectives and to ensure compliance with company policies. Tracks, monitors, manages and distributes work and assignments to appropriate CC staff in accordance with job descriptions, practice level, and business needs. Works closely with Health Services leadership to develop meaningful performance measures to determine the quality, effectiveness, and efficiency of department operations in achieving desired outcomes. Assists in survey-readiness activities to ensure the department is compliant with all applicable regulations, licensure requirements, accreditation standards (i.e. NCQA), and new legislation. Provides administrative, technical, and clinical management of assigned staff in accordance with industry best practices which includes training oversight, the responsibility for hiring, performance evaluation, performance improvement, education, staff development, work allocation and problem resolution. Performs random auditing and review of all case management activities to ensure DHCS compliance standards are achieved. Provides a summary of findings to Health Services leadership as requested. Provides direction and oversight to ensure efficient and appropriate collaboration between the CC staff and the delegated mental health provider and other internal and external organizations. Provides oversight of training program to ensure adequate training accomplishes objectives and results in staff competency. Works with other departments to resolve claims, grievance, UM, QI, RAC and member issues as necessary. Develops structures, relationships, and processes to promote active partnerships with providers, community stakeholders, and/or other healthcare professionals to meet and support key organizational initiatives (ex: MOU requirements, CalAIM, etc.) Ensures compliance with all departmental and organizational policy and procedures; develops and works with leadership to implement standardize processes to achieve efficient operations for the provision of optimal patient care. Reviews appropriate scope of practice by staff. Ensures that all team members are familiar with prominent professional standards especially related to issues such as confidentiality, informed consent, conflicts of interest, dual relationships, boundary issues, documentation, consultation, etc. Participates in all audits or surveys as requested by preparing documentation or reports as needed. Communicates activities and promotes continuous process improvement to ensure activities are appropriately managed with other departments and providers both within and outside the organization. Participates in and provides leadership in identifying, developing and advancing departmental goals to further organizational goals and mission. Reviews and participates in operationalizing newly released All Plan Letters (APL) Provides yearly update and review of CC designated Policies and Procedures Identifies opportunities for improvement in Care Coordination workflow processes to ensure high quality case management services are delivered Participates in process improvement projects to improve Case Management programs as needed Performs Human Resource functions such as time card management, directing work activities, implementing workplace changes, conducting annual reviews, and conducting staff trainings. Serves as a role model and resource to colleagues, staff, members, and others across assigned regional offices. Leads the interview process for other staff within the department. Maintains clear and appropriate employee performance files for direct reports, and mentors supervisory staff in this area Holds individual staff meetings designed to identify performance level and assist with career growth and progression for assigned direct reports. Other duties as assigned.

Requirements

Bachelors of Science in Nursing preferred; minimum five (5) years acute care experience, two (2) years managed care experience; or equivalent combination of education and experience.
Minimum one (1) year prior experience in a leadership or management role.
Current California Registered Nurse License.
Strong knowledge of nursing standards in both inpatient and outpatient settings.
Strongly leadership, program evaluation and management skills.
Thorough knowledge of Care Coordination, Discharge Planning, Case Management and Utilization Review within a managed care environment.
Familiarity of business practices and protocols accessing data sets and information using automated systems.
Ability to work within an interdisciplinary structure and function independently in a fast-paced environment while managing multiple priorities and deadlines.
Strong organizational skills required.
Computer literacy and proficiency.
Valid California Driver's License and proof of current automobile insurance compliant with Partnership’s policies are required to operate a vehicle and travel for company business.
Excellent written and verbal communication skills in English.
Demonstrated experience and ability to build effective working relationships and to represent the department effectively in order 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.
Ability to supervise, train, motivate, provide guidance to staff

Nice To Haves

Certifications in chosen field such as advance practice nursing or case management.

Responsibilities

Provides day-to-day direction to CC Supervisors, and licensed and non-licensed CC staff to meet department goals and objectives and to ensure compliance with company policies.
Tracks, monitors, manages and distributes work and assignments to appropriate CC staff in accordance with job descriptions, practice level, and business needs.
Works closely with Health Services leadership to develop meaningful performance measures to determine the quality, effectiveness, and efficiency of department operations in achieving desired outcomes.
Assists in survey-readiness activities to ensure the department is compliant with all applicable regulations, licensure requirements, accreditation standards (i.e. NCQA), and new legislation.
Provides administrative, technical, and clinical management of assigned staff in accordance with industry best practices which includes training oversight, the responsibility for hiring, performance evaluation, performance improvement, education, staff development, work allocation and problem resolution.
Performs random auditing and review of all case management activities to ensure DHCS compliance standards are achieved.
Provides a summary of findings to Health Services leadership as requested.
Provides direction and oversight to ensure efficient and appropriate collaboration between the CC staff and the delegated mental health provider and other internal and external organizations.
Provides oversight of training program to ensure adequate training accomplishes objectives and results in staff competency.
Works with other departments to resolve claims, grievance, UM, QI, RAC and member issues as necessary.
Develops structures, relationships, and processes to promote active partnerships with providers, community stakeholders, and/or other healthcare professionals to meet and support key organizational initiatives (ex: MOU requirements, CalAIM, etc.)
Ensures compliance with all departmental and organizational policy and procedures; develops and works with leadership to implement standardize processes to achieve efficient operations for the provision of optimal patient care.
Reviews appropriate scope of practice by staff.
Ensures that all team members are familiar with prominent professional standards especially related to issues such as confidentiality, informed consent, conflicts of interest, dual relationships, boundary issues, documentation, consultation, etc.
Participates in all audits or surveys as requested by preparing documentation or reports as needed.
Communicates activities and promotes continuous process improvement to ensure activities are appropriately managed with other departments and providers both within and outside the organization.
Participates in and provides leadership in identifying, developing and advancing departmental goals to further organizational goals and mission.
Reviews and participates in operationalizing newly released All Plan Letters (APL)
Provides yearly update and review of CC designated Policies and Procedures
Identifies opportunities for improvement in Care Coordination workflow processes to ensure high quality case management services are delivered
Participates in process improvement projects to improve Case Management programs as needed
Performs Human Resource functions such as time card management, directing work activities, implementing workplace changes, conducting annual reviews, and conducting staff trainings.
Serves as a role model and resource to colleagues, staff, members, and others across assigned regional offices.
Leads the interview process for other staff within the department.
Maintains clear and appropriate employee performance files for direct reports, and mentors supervisory staff in this area
Holds individual staff meetings designed to identify performance level and assist with career growth and progression for assigned direct reports.
Other duties as assigned.