Manager, Clinical Care Management
Gold Coast Health Plan
Clinical Care Manager
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 health care and social determinants of health needs
- Promote positive health outcomes and act as an advocate and liaison between providers, members and GCHP
- Identify members who can benefit from care coordination services and reduce consumption of health care services
- Mentor staff and develop a cohesive team environment
- Work with community agencies to collaborate on mutually benefitting initiatives
- Participate in development of programs to identify members at risk for care management services
- Develop protocols to review, screen and prioritize cases for possible case management services
- Develop tools to ensure the delivery of comprehensive care management services
- Mentor staff to ensure protocols and workflows are being followed and that Care Management services are efficient and effective
- Identify problems through dialog with staff and institute solutions that improve or correct deficiencies
- Ensure staff are included in department decisions to ensure support for new processes
- Develop auditing methodologies to provide feedback to staff on areas where improvements may be needed
- Identify deficiencies in appropriate health care resources and work with other Gold Coast Departments to resolve issues
- Participate in development of an annual Care Management Work Plan and annual evaluation outlining goals, objectives and accomplishments
- Continually reassess department staffing needs to ensure adequate resources are available
Requirements
- Bachelor's Degree required, from an accredited institution of advanced learning in a clinical area such as, but not limited to, Licensed Clinical Social Worker, Registered Nurse, Physical Therapist, Occupational Therapist, Behavioral Health Therapist
- Master’s degree preferred
- 5 plus years of paid experience in clinical specialty dealing with complex patients/members
- 5 plus years of paid experience in managed care preferred
- 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 required
- Strong organizational and prioritization skills
- Excellent communication skills verbally and in writing
- Proficient in computer programs included in the MS Office products
