Manager, Clinical Care Management

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.

Work Culture:

GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive. This philosophy enables us to create the health plan of the future and do our best work - Together.

GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).

GCHP's focuses on 5 Core Values in the workplace:

* Integrity

* Accountability

* Collaboration

* Trust

* Respect

Disclaimers:

* Flexible work schedule is based on job duties, department, organization, or business need.

* Gold Coast Health Plan will not sponsor applicants for work visas.

POSITION SUMMARY

The Manager, Clinical Care Management is responsible for the development of a comprehensive program to coordinate medical and social services that lead to the cost-effective management of health care resources that meet the individual members' health care and social determinants of health needs. The program will promote positive health outcomes; provide support to the member and member's care team by acting as an advocate and a liaison between providers, members and GCHP to seamlessly integrate complex services. The program will include mechanisms to identify members who can benefit from care coordination services with a resulting improvement in health status and a reduction in the consumption of health care services. The Manager, Clinical Care Management will mentor staff through use of judgment, independent analysis, and critical-thinking skills and through development of a cohesive team environment.

This position is differentiated from other Manager positions in the organization by the large staff of Registered Nurses, Social Workers, and Support staff that manage the day-to-day efforts of Care Management at GCHP, as well as the work with community agencies to collaborate on mutually benefitting initiatives.

Amount of Travel Required: up to 75%

Work Schedule: Travel to multiple sites and locations. Protracted work hours or irregular work hours and evening meetings, or unusual work hours for attendance at meeting for special projects and programs.

ESSENTIAL FUNCTIONS

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Essential Functions Statements

* Participate in the development of programs to proactively identify members at risk who are appropriate for care management services.

* Develop protocols to review, screen and prioritize cases for possible case management services.

* Develop tools to ensure the delivery of comprehensive care management services.

* Mentor staff to ensure protocols and workflows are being followed and that Care Management services are efficient and effective.

* Identify problems through dialog with staff and institutes solutions that improve or correct deficiencies.

* Ensure staff are included in department decisions to ensure support for new processes.

* Develop auditing methodologies to provide feedback to staff on areas where improvements may be needed.

* Identify deficiencies in appropriate health care resources and works with other Gold Coast Departments to resolve issues.

* Participates in the development of an annual Care Management Work Plan and annual evaluation that outlines the goals, objectives and accomplishments of the Care Management Department.

* Continually reassesses department staffing needs to ensure adequate resources are available.

POSITION QUALIFICATIONS

Competency Statements

* Management Skills - Ability to organize and direct oneself and effectively supervise others.

* Presentation Skills - Ability to effectively present information publicly.

* Detail Oriented - Ability to pay attention to the minute details of a project or task.

* Team Builder - Ability to convince a group of people to work toward a goal.

* Conflict Resolution - Ability to deal with others in an antagonistic situation.

* Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.

* Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.

SKILLS & ABILITIES

Education:

* Bachelor's Degree required, from an accredited institution of advanced learning in a clinical area such as, but not limited to, Licensed Clinical Social Worker, Registered Nurse, Physical Therapist, Occupational Therapist, Behavioral Health Therapist.

* Master's degree preferred.

Experience:

* 5 plus years of paid experience in clinical specialty dealing with complex patients/members

* 5 plus years of paid experience in managed care preferred

Computer Skills: Proficient in computer programs included in the MS Office products.

Certifications & Licenses:

* Active, valid and unrestricted license as appropriate to specialty in the State of California.

* CCM or ACM certification required upon hire or within six months of employment.

Other Requirements:

* Working knowledge federal and state regulations/requirements related to managed MediCal and MediCare.

* Extensive knowledge of Care Management Principles.

* Strong analytical and problem-solving skills required.

* Strong organizational and prioritization skills.

* Excellent communication skills verbally and in writing.

* Ability to effectively analyze, interpret, apply and communicate policies, procedures and regulations.