Manager, Case Management Nurse Management- Population Health Management

About the role

The Care Management team is looking for a leader with Care Management experience who can help design and lead our Population Health Management (PHM) – Medi-Cal Care Management line of business. The Manager, Care Management will report to the Director of Care Management-PHM.

Responsibilities

• Establish operational objectives for department or functional area and participate with other managers to establish group objectives
• Be responsible for team, department, or functional area results in terms of planning, cost in collaboration with the Director
• Ensure workflow procedures and guidelines are clearly documented and communicated
• Interpret or initiate changes in guidelines/policies/procedures
• Responsible for the overall effectiveness of the assigned business unit. This position oversees the day-to-day operations of business units and execution of departmental goals and objectives, to promote the delivery of quality, cost-effective healthcare services based on medical necessity and contractual benefits across the continuum of care.
• Works collaboratively among business units to align and partner with others to achieve performance goals and/or outcomes
• Interprets and applies policies and procedures and makes decisions on a variety of matters consistent with goals and objectives of group
• Provides guidance and leadership for team members; monitors on-going performance; communicates expectations and results on a regular basis; communicates and interprets changes in guidelines, policies, procedures and other related matters

Qualifications

• Current CA RN License
• Bachelor of Science in Nursing or advanced degree preferred
• Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements
• Comprehensive knowledge of case management, discharge planning, utilization management, long term care, and community resources
• Strong supervisory, communication and negotiation skills
• Able to operate PC-based software programs including proficiency in Word and Excel
• Case Management, Quality or other equivalent certification that is related to the specific area to be managed is required
• Demonstrates professional judgment, and critical thinking, to promote the delivery of quality, cost-effective care
• Demonstrated leadership, project management and program evaluation skills and ability to interact with all levels including senior management and influence decision-making
• Strong supervisory, communication and negotiation skills