Manager, Care Management
Company: L.A. Care Health Plan
Location: Los Angeles
Posted on: May 24, 2020
Established in 1997, L.A. Care Health Plan is an independent
public agency created by the state of California to provide health
coverage to low-income Los Angeles County residents. We are the
nation's largest publicly operated health plan. Serving more than 2
million members in six health plans, we make sure our members get
the right care at the right place at the right time.
The Manager, Care Management Medical Management is directly
responsible for the oversight and monitoring of care management
functions, organization, direction and staffing of L.A. Care's Case
Management function(s) including but not limited to Complex Case
Management/Case Management, Care Coordination and Special Programs
Outreach. Responsibility includes regulatory compliance,
accreditation compliance, oversight of Plan Partners' and Delegated
Provider Groups related operations, oversight of care management
related delegated functions, operations for direct lines of
business and/or management services agreement functions, and
interfacing with external agencies including other Local
Initiatives, Plan Partners and external organizations. The Manager,
Case Management Medical Management is further responsible to assure
all functions are operating in accordance with the organization's
mission, values and strategic goals and are provided in a manner
that is responsive and sensitive to the needs of L.A. Care's
culturally diverse membership.
General Essential functions: Responsible for the ensuring overall
staff management and operational functions associated with the Care
Management department. Functions include Complex Case Management,
Case Management, Care Coordination, and Special Programs (i.e. CCS,
Regional Center) functions. Assures departmental compliance with:
All contracts (i.e. CMS, DHCS, Covered California, PASC-SEIU, First
5LA, etc.), DMHC regulations, applicable state and federal
regulations, Management Services Agreements & Other Contracts.
Oversees and monitors operational compliance with organizational
standards, policies and procedures and regulatory requirements.
Assures department meets all regulatory time frames on CM. Develops
and implements departmental policies and procedures. Develops and
maintains departmental statistical and performance reports.
Develops, implements and monitors performance standards. Develops
and maintains effective communication mechanisms at various levels
of the organization and with external organizations. Develop and
maintain departmental budgets in line with organizational goals.
Ensuring the maintenance of positive relationships between Plan
Partners and PPGs. Identifies and implements, with approval,
programs that improve the provision of services to members. Directs
measurement and analysis of Plan Partner and delegated PPG
functions. Assures completion of ongoing monitoring, audits,
corrective action plan and necessary follow-up. Facilitates
communication to and involvement of Plan Partners. Assures
appropriate communication and coordination with CBOs and other
external agencies. Facilitates data flow, analyzes, reports, design
formats, interprets data and recommends alternatives/solutions
internally and externally. Requests assistance from Director as
needed to accomplish goals.
Maintains confidentiality in compliance with all HIPAA
requirements. Communicates to supervisors any barriers to
completing assignments or daily work in an efficient and effective
manner. Demonstrates reliability and good attendance and
Human Resource Management: Daily staff supervision and oversight.
Develops and maintains a culturally sensitive work environment that
promotes staff growth and education. Completes performance
appraisals in accordance with established policies and based upon
achievement of the L.A. Care mission, value, objectives and
management expectations. Assures staff have access to appropriate
training and educational opportunities. Recruits appropriately
qualified candidates, with approval of Director. Counsels and
coaches staff in consultation with Director and in conjunction with
HR. Participates in the hiring and termination of staff with
Director and in conjunction with HR.
In conjunction with Director of CM, responsible for oversight and
adequate performance of direct line of business PPG delegated
activities. Develops and sustains active communications with PPGs.
Identifies performance issues or opportunities for improvement
within PPG UM operations that impact compliance. Collaborates with
Oversight Staff on identifying topics and agenda items for the PPG
Performs other duties as assigned.
Associate's Degree or Bachelor's Degree in RN
At least 9 years of clinical nursing experience.
At least 3-5 years of management/supervisory experience and
relevant health plan experience.
Experience with Medi-Cal and Medicare populations and regulatory
Experience with Medi-Cal, under-served and culturally diverse
Experience with state Medi-Cal regulations.
Excellent verbal and written communication skills.
Strong problem solving, planning, and organizational skills.
Current and unrestricted CA RN License
L.A. Care offers a wide range of benefits including
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
Keywords: L.A. Care Health Plan, Los Angeles , Manager, Care Management, Executive , Los Angeles, California
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