Manager of Case Management (PHM)- Bakersfield 1.1

Universal Healthcare MSO LLC•Bakersfield, CA

39d•$60 - $75•Onsite

About The Position

The Population Health Management (PHM) Manager is responsible for the daily oversight and coordination of PHM case management programs serving Medi-Cal, Medicare, and D-SNP members. This includes the full PHM model of care: Health Risk Assessments (HRAs), Initial Assessments, Individualized Care Plans (ICPs), Interdisciplinary Care Team (ICT) facilitation, ongoing case management, and specialized programs such as Integrated Care Coordination Services, Complex Case Management (CCM), and California Integrated Care Management (CICM). The Manager supervises and supports embedded case management staff within the TOC Clinic and PCMH, as well as office-based and outreach staff engaging members by phone and in person. The Manager ensures compliance with regulatory and health plan requirements, provides coaching and training to staff, monitors productivity and quality, and collaborates with Utilization Management (UM) and Quality teams to achieve shared goals such as reducing avoidable ER visits, inpatient admissions, and readmissions, and improving healthcare gap closure, HEDIS, and Stars Ratings.

Requirements

Registered Nurse (RN), active and unrestricted license in California required.
Bachelor of Science in Nursing (BSN) required, obtain BSN degree within 2 years of hire.
Minimum 3 years of nursing experience; experience in case management or care coordination preferred.
Knowledge of Medi-Cal, Medicare, D-SNP, NCQA, CMS, and DHCS requirements.
Experience supervising multidisciplinary teams across clinic, office-based, and outreach settings.
Advanced clinical judgment, assessment, and decision-making skills.
Strong leadership, coaching, and mentoring skills to enhance staff education, performance, and professional growth.
Demonstrated cultural competence, respect, and sensitivity when working with diverse and multicultural populations.
Demonstrated ability to manage reports, data analytics, and performance dashboards to monitor outcomes and drive process improvements.
Knowledge of professional nursing principles, case management practices, medical terminology, chronic condition management, and community resources.
Familiarity with Medicare, Medi-Cal, and D-SNP regulatory environments, including CMS, DHCS, and NCQA standards.
Proficiency in evidence-based communication techniques (e.g., Motivational Interviewing) and member engagement strategies.
Excellent verbal and written communication skills, with ability to prepare professional reports, correspondence, and presentations.
Strong organizational skills with high attention to detail, accuracy, and problem-solving ability.
Proficiency in data interpretation, performance monitoring, and electronic Case Management systems.
Technical proficiency in Microsoft Office (Word, Excel, PowerPoint), databases, and internet-based tools.
Ability to work effectively both independently and as part of an interdisciplinary team, while adapting to changing environments.
Commitment to professionalism, continuous learning, and quality improvement.

Nice To Haves

Supervisory or management experience preferred.

Responsibilities

Provide supervision, training, mentoring, resources, and monitoring to clinical and non-clinical PHM staff per departmental policies and health plan requirements.
Manage and monitor case assignments and staff caseload distribution; ensure equitable assignments and compliance with productivity standards.
Establish, implement, and oversee orientation, training, and competency plans for Case Management staff to promote consistency and program adherence.
Enhance the skills and education of case management staff through coaching, ongoing education, professional development opportunities, and performance feedback.
Maintain time and attendance records for designated employees.
Manage and participate in new hire recruitment, onboarding, and employee evaluation processes.
Provide education to Case Management staff related to member assessment completion, ICP development, and follow-up according to PHM policies and guidelines.
Oversee delivery of the PHM model of care, including HRAs, Initial Assessments, ICPs, ICT facilitation, and ongoing case management programs (Integrated Care Coordination, CCM, CICM).
Develop, maintain, and communicate PHM policies and procedures, ensuring ongoing staff adherence and compliance.
Collaborate with other disciplines to oversee development, implementation, monitoring, and modification of member care plans through an interdisciplinary approach.
Develop and implement staff schedules, ensuring adequate coverage for all care management activities.
Conduct regular staff meetings to disseminate information, address concerns, and facilitate collaboration.
Facilitate interdisciplinary care meetings and assist in identifying opportunities for member care and program improvement.
Perform routine case audits to verify compliance with standards of care, documentation, and service delivery.
Review and audit outbound reporting for accuracy and compliance. Work with IT Analytics to ensure updates and corrections are made.
Track and respond to internal and external feedback regarding PHM services and staff.
Manage reports, data collection, and analysis to monitor program performance; make recommendations for process improvements.
Facilitate and participate in audit reviews; develop and implement corrective action plans when needed.
Partner with Utilization Management on discharge planning, care transitions, and avoidable utilization reduction.
Collaborate with Quality to improve gap closure, HEDIS, and Stars Rating performance.
Work closely with the Medical Director and organizational leadership team regarding service objectives and program alignment.
Represent PHM in cross-department committees and interdisciplinary team discussions.
Perform other duties and projects as assigned.