Gold Coast Health Plan

Manager, Clinical Care Management

Gold Coast Health Plan

full-time

Posted on:

Location: California • 🇺🇸 United States

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Salary

💰 $110,250 - $183,750 per year

Job Level

Mid-LevelSenior

About the role

  • Develop and manage a comprehensive Care Management program to coordinate medical and social services
  • Promote positive health outcomes and cost-effective management of health care resources
  • Act as advocate and liaison between providers, members and GCHP to integrate complex services
  • Develop protocols to review, screen and prioritize cases for case management services
  • Develop tools to ensure delivery of comprehensive care management services and auditing methodologies
  • Mentor and supervise a large staff of Registered Nurses, Social Workers, and support staff; ensure protocols and workflows are followed
  • Identify problems through dialog with staff and implement solutions to improve deficiencies
  • Ensure staff inclusion in department decisions and continually reassess staffing needs
  • Participate in development of annual Care Management Work Plan and annual evaluation
  • Collaborate with community agencies and other Gold Coast departments to resolve resource deficiencies
  • Travel to multiple sites and locations; attend evening meetings and work irregular hours as needed

Requirements

  • Bachelors Degree required 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
  • 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
  • Proficient in computer programs included in the MS Office products
  • 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 travel to multiple sites and locations (up to 75%) and work protracted/irregular hours, including evenings
  • Gold Coast Health Plan will not sponsor applicants for work visas (must have work authorization)
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