Manager Case Management

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OverviewnThe Program Manager, Care Management role will serve as the leader for care and case managers, social workers, and clinical service coordinators within Altura MSO care management. This role will include supervising the case management leadership team, developing policies and procedures, desk top level procedures, analyzing day to day reporting, audit preparation, provide mentorship, and assist with performance appraisals. This role will also function as the subject matter expert on professional nursing/care management for regulations and requirements who will represent care/case management in initiatives, client presentations, act as a liaison between other business units within Altura/AltaMed to bolster care/case management knowledge on community resources, best practices, and promote holistic and integrated approach to medical care management. The Program Manager will need to be energized, creative, critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.n nResponsibilitiesnEstablish operational objectives for department or functional area and participates with other managers to establish group objectives. nSupervision of the case management leadership team. nDevelop policies/procedures including desk top level procedures. nEnhancement or creation of care management processes in compliance with regulatory requirements. nEnsure workflow procedures and guidelines are clearly documented and communicated to all staff.nResponsible for ensuring care management department readiness for government, accreditation, and health plan audits.nAssist clinical trainer with audit preparation.nParticipate in health plan rounds and meetings.nAssist with performance appraisals. nProvide leadership to ensure best utilization of resources in obtaining organizational goals, regulatory compliance, adhering to corporate policies through oversight of daily operations, assessment of adequacy of staffing, and adherence to standard of social workers.nDemonstrates a passion for leading positive change by enhancement and sustainment of an innovative care management program that advocates for patient safety by keeping informed of mandates, regulations, and best practice innovations.nPromotion of best practice in impacting social determinants of health and homelessness.nRegular collaboration with Altura care management leaders and staff and other business units.nCreate and maintain measurement standards and outcomes for all staff.nOther duties as assigned.nQualificationsnCurrent CA RN License required. nMinimum of 7 years of relevant experience required.nMinimum of 4 years of management experience as a team leader, supervisor or project/program manager preferred.nRequires health insurance/managed care experience (Commercial, Medicare, and Medi-Cal).nRequires knowledge of the Committee for Quality Assurance (NCQA) requirements.

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