Product Manager
Cayuse Holdings
Manager, Clinical Care Management
Gold Coast Health Plan
full-time
Posted on:
Origin: • 🇺🇸 United States • California
Visit company websiteSalary
💰 $110,250 - $183,750 per year
Job Level
Mid-LevelSenior
About the role
- Develop a comprehensive program to coordinate medical and social services for members to meet healthcare and social determinants of health needs.
- Promote positive health outcomes and reduce consumption of healthcare services through care coordination.
- Act as an advocate and liaison between providers, members and GCHP to integrate complex services.
- Identify members who can benefit from care coordination and develop mechanisms for identification.
- Develop protocols to review, screen and prioritize cases for case management services.
- Develop tools to ensure delivery of comprehensive care management services.
- Mentor staff (Registered Nurses, Social Workers, Support staff) and ensure adherence to protocols and workflows.
- Identify problems with staff dialogue and institute solutions to improve deficiencies.
- Include staff in department decisions to support new processes.
- Develop auditing methodologies to provide feedback and areas for improvement.
- Identify deficiencies in healthcare resources and coordinate with other departments to resolve issues.
- Participate in development of annual Care Management Work Plan and evaluations.
- Continually reassess department staffing needs to ensure adequate resources.
Requirements
- Bachelors Degree required from an accredited institution in a clinical area (e.g., Licensed Clinical Social Worker, Registered Nurse, Physical Therapist, Occupational Therapist, Behavioral Health Therapist).
- Masters degree preferred.
- 5 plus years of paid experience in clinical specialty dealing with complex patients/members (minimum requirement).
- 5 plus years of paid experience in managed care preferred.
- Proficient in computer programs included in the MS Office products.
- Active, valid and unrestricted license as appropriate to specialty in the State of California.
- CCM or ACM certification required upon hire or within six months of employment.
- Working knowledge federal and state regulations/requirements related to managed MediCal and MediCare.
- Extensive knowledge of Care Management Principles.
- Strong analytical and problem-solving skills.
- Strong organizational and prioritization skills.
- Excellent communication skills verbally and in writing.
- Ability to effectively analyze, interpret, apply and communicate policies, procedures and regulations.
- Management, presentation, detail-oriented, team-building, conflict resolution, goal-oriented, and diversity-oriented competencies.
- Ability to travel up to 75% and work protracted/irregular hours including evenings as needed.
