Five years prior experience in managed care environment within the areas of Care Coordination.
Bachelors Degree or combination of education and experience
445 Grant Avenue, San Francisco, CA 94108
The Care Coordination Manager leads the Care Coordination team and oversees the day to day operation of the department reporting to the Chief Medical Officer. Programs in this department are a combination of post discharge, disease, and case management. The purpose is to assure that members have access to quality, cost-effective health care and assists in the assessment, coordination, teaching aimed at self-management, and monitoring activities to facilitate member care. As needed, the supervisor is expected to perform the duties of Care Coordinators including, but not limited to coordination of services for an assigned caseload of enrollees.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Oversee activities of the Care Coordination staff.
- Manage data referrals and census reports for prompt identification and response for member outreach.
- Performs daily member care coordination assignments as necessary.
- Delegates tasks or assigns activities to appropriate care team members to implement the plan of care.
- Monitor and measure effectiveness of post discharge program, disease and case management programs.
- Ensure clinical and administrative compliance in all program areas.
- Annually review and update policies used for post discharge, disease and case management programs.
- Utilizes evidence-based guidelines such as Milliman Care Guidelines and other tools such as HealthWise.
- Collaborates and coordinates with other healthcare professionals in the management and implementation of care within and across care settings and communities.
- Facilitates bi-weekly care coordination conferences with the interdisciplinary team including, but not limited to the care coordination team, UM manager, and Medical Director.
- Documents and manages meeting minutes from case conferences.
- Thorough understanding of care management system and other applications for the day to day operations.
- Responsible for reporting and data trending when indicated.
- Participates in regulatory, accreditation and third-party administration audits of the Care Coordination programs.
- Provides and supervises nurse advice line services during CCHP operation hours.
- Constantly evaluates Care Coordination tools including Essette and works with relevant internal and external stakeholders on upgrades and any changes.
- Monitors all Care Coordination platforms and evaluates the need for changes as they may arise.
- Participates in relevant internal and external training when indicated.
- Identifies and provides training of new Care Coordination staff and ongoing training for Care Coordination team.
- Help interview and assist in the hiring process for vacant positions.
- Participates in team, departmental, and organization meetings.
- Constantly evaluates staff performance and manages issues as indicated.
- Performs annual staff performance evaluations and works with the CMO on both promotions when indicated and Corrective Action Plans (CAPS) when indicated.
- Works closely with the Chief Medical Officer (CMO) in developing and implementing new processes and procedures directed at optimal Care Coordination processes.
- Monitors Case management staff ratios and ensures that ratios comply with industry standards.
- Reviews annual budget and manages with CMO.
- Accepts and performs other duties as assigned.
- Registered Nurse (RN) with current, active, and unrestricted license in California
- Bachelor’s degree in Nursing or equivalent experience
- Two to five years’ experience in Home Health, Discharge Planning, Case Management, Utilization Review and/or recent nursing experience with previous leadership experience preferred
- Strong organizational skills, including the ability to prioritize projects and activities, meet deadlines and work under time constraints
- Able to communicate and collaborate effectively with physicians and allied health care providers
- Able to work independently and as a team player
- Able to speak Chinese to interact with members as appropriate. Must possess excellent written and oral communication skills
- Proficient use of common Microsoft applications such as Word, Excel, and Outlook
- Able to lift up to 30 pounds
- Use proper body mechanics when handling equipment
- Standing, walking and moving 50% of the day.
In our efforts to control the spread of COVID-19 and its variants, CCHP requires that its employees be fully vaccinated as of their start date. If you require a medical or religious accommodation we will engage in the interactive process with you. Proof of vaccination will be required prior to start. If we make you an offer and you are not yet vaccinated, we will accommodate a delay in start date. CCHP may also mandate that its employees receive vaccine boosters, and all accommodation laws will be followed.