Senior Manager, Care Management

Oversight

Oversight the performance of the Care Management team, including the direction, planning, implementation and continuous improvement of all care management activities.
Provide direct oversight and guidance to the Clinical Supervisors and other staff as needed, thereby creating a high-performing team.
Escalate issues for clinical and operational issues from staff, members and providers.
Model data-driven quality improvement as it applies to Care Management programs and large-scale initiatives.

Regulatory Compliance

Understand and execute regulatory requirements for Care Management programs by all governing bodies, including DHCS, DMHC and NCQA, encompassing responsibility for audit preparation presentations and follow up.

Policies and Procedures

Develop and updates to multiple policy and procedures, desktop procedures, workflows and department documents.

Collaboration and Education

Guide collaboration through participation in Care Management and enterprise-wide initiatives.
Ensure the quality of ongoing education provided to the CM staff.

Metrics and Reporting

Responsible for Care Management program metrics and annual goals, at the organizational level and at the individual staff level.
Analyze business processes, systems, and data to identify areas for improvement and new opportunities.
Prepare reports on Care Management activities according to established schedules and format.
Identify patterns and trends and, in collaboration with the Director, develop and implement corrective action plans, where necessary.

Partnerships and Resource Management

Develop partnerships with peer functional leaders from other teams to help maximize company resources and deliver positive outcomes.
Responsible for department budgetary resources, including bonus allocation in a pay-for performance plan.
Collaborate with the Health Services Product Management and Business Analytics teams to update and monitor the CM dashboards monthly, while analyzing and reporting overall trends to the Director.

Leadership and Expertise

Provide clinical leadership and expertise when needed across the Health Services department and health plan as a whole.

Privacy and Security

Ensure the privacy and security of PHI (Protected Health Information) as outlined in SFHP's policies and procedures relating to HIPAA compliance.

Workload and Budget

Monitor workload including making recommendations for budgetary purposes.
Develop and implement staff hiring and retention strategy in collaboration with the Clinical Supervisors.

Care Management System Optimization

Ensure the care management system is being optimized to support new and evolving programs.
Cross train all department programs to ensure they can provide coverage and address operational gaps as needed.