Manager of Case Management (RN Required) (San Diego)

Job description :

JOB TITLE : Clinical Manager of Care Management

COMPANY : IHP

REPORTS TO : Director of Clinical Strategy

DIRECT REPORTS : None

STATUS : Exempt / FULL-TIME

OUTSIDE TRAVEL : 25%

WORK SCHEDULE : 7-7 / M-F (Flexible 9 / 80 schedule)

WORK CONDITIONS : Remote

This job description is intended to be a general statement about this job and is not to be considered a detailed assignment. It may be modified at any time, with or without advance notice, to meet the needs of the organization.

Job Summary

Under the direction of the Medical Director and Director of Clinical Strategy, the position is responsible for leading and coordinating care management services across the network that include care coordination and activities that promotes the quality, cost, and experience of care. The position is responsible for developing a vision and executable plan to attain high quality performance for the clinically integrated network through partnership with the FQHC members, health plans and vendor partners and must understand care management principles, quality management and healthcare reimbursement models.

Essential Job Functions

• Hire and manage a team of care manager (RNs and LVNs) plus health care liaisons
• Build a Care Management program strategically aligned with a hybrid network model to ensure success in risk-based contracts.
• Partner with the PHIT and IT vendor teams to develop innovative care management methods utilizing technology, tools, and teams.
• Build the Arcadia Care Management module to meet the needs of the FQHC based network.
• Become a clinical resource to member health centers for care management best practices.
• Identify at risk populations and provide clinical coordination necessary to improve quality of care and control cost for patients attributed to IHPs network.
• Coordinate care between health plans and health centers to ensure there is a cohesive plan to help patients achieve optimal health outcomes.
• Review payer and Arcadia quality performance reports to identify the quality metrics that are performing below performance thresholds and develop and implement clinical action plans to address gaps in care, access, and / or quality outcome issues.
• Work with clinicians and key stakeholders to develop, maintain, and monitor the implementation of the care management strategies that support value-based contracts.
• Apply and teach clinical techniques for quality improvement, outcomes measurement and statistical analysis to advance quality and improve health equity of communities.
• Conducts comprehensive assessments to address the whole-person client needs.
• Create care plans for clients with short and long-term goals and the steps to achieve those goals.
• Facilitate and coordinate care needs for identified clients that promote quality and controls cost.
• Evaluate clients progress, making adjustments to plan of care as needed to improve outcomes.
• Prepare case related reports that include clinical summary, barriers to goals, outcomes, and prognosis.
• Follow up on client referrals to ensure that clients can access and receive necessary services in a timely manner.
• Coordinate and provide care that is safe, timely, effective, efficient, equitable, and client centered.

Utilization Management

Coding & Documentation Integrity

Other

Qualifications

Skills

Education / Experience

Physical Requirements

HIPAA / Compliance

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.

The pay range for California residents for this position is $104,000-$135,000, however, the actual base pay offered may vary depending on skills, experience, job- related knowledge and location.