The position provides shared responsibility for the daily operations, activities and projects for the Case Management Department. This position will work under the general direction of the Director of Case Management and in partnership with the other department managers to provide performance management and development of the case management staff and projects associated with the department to ensure compliance with department policies and procedures along with the implementation of assigned projects. This position may require attendance at Joint Operational Meetings (JOMs), monitoring of case management reports and reporting to management or committees.
Bachelor’s degree in public health, health care, or related field; or equivalent work experience is required. Master’s degree preferred. Active and unrestricted RN license or LCSW license to practice in the State of California required. 5 + years of managed care experience required. 5+ years of management level experience required. Active CCM certification preferred. National Committee for Quality Assurance (NCQA) QI 5 Standards; Complex Case Management. Principles and practices of managed health care. Appropriate strategies to serve diverse social and ethnic groups. Principles of effective supervision, team leadership, and staff engagement. Maintain and ensure confidentiality of patient information. Effectively communicate, verbally and in writing, complex material to others regardless of experience level. Think analytically to evaluate potential courses of action. Develop creative/innovative approaches to challenges and opportunities. Adeptly utilize and access computer programs – both Microsoft Office applications and job-specific applications like Facets and Guiding Care. Think independently and disagree constructively with peers and bosses. Document and manage process for projects. Effectively engage and lead a team of more than 20 employees or smaller teams of less than 5 toward a common goal or set of goals.
Must have ability to: Hire, manage, train, review, and set goals for department and staff. Work with the Director in the development, implementation and evaluation of the department’s case management policies and procedures. Ensure programs, policies and procedures are in alignment with CMS, DHCS and NCQA standards. Collect, analyze and respond to data regarding overall and individual case management effectiveness. Adeptly and aggressively develop and implement complex project plans which will improve efficiencies, outcomes and satisfaction and which may be directed by federal and/or state regulations. Develop and maintain relationships with providers, networks and groups to serve as a liaison between the Health Plan and the provider. Identify cases requiring Director or Medical Director review or intervention and route appropriately. Work in partnership with the other Case Management managers to meet all project deadlines. Maintain department budget. Other projects and duties as assigned.
Application Process: For a complete job description and to apply online, please go to www.caloptima.org. Questions can be directed to Debbie Neal, Senior Recruiter, 657-235-6891 or firstname.lastname@example.org.
Internal Number: 12051
CalOptima is a county organized health system that administers publicly funded health care coverage for low-income children, adults, seniors and people with disabilities in Orange County, California. CalOptima’s mission is to provide members with access to quality health care services delivered in a cost-effective and compassionate manner. With $3.4 billion in annual revenue, CalOptima serves nearly 800,000 members, delivering services through 14 health networks. For the past three years, CalOptima has been rated the top quality Medi-Cal plan in California, according to the National Committee for Quality Assurance (NCQA) Medicaid Health Insurance Plan Ratings 2017–2018.