RN Pediatric Manager of Case Management - Health Plan

Location: Santa Cruz, CA
Date Posted: 02-01-2018
RN Pediatric Manager of Care Management - Managed Care
Santa Cruz, CA
Your Job Summary:
Manager of Case Management provides clinical leadership for all Health Care Services programs by serving as an educator, role model, member advocate, and change agent to enhance member care and staff competency.  The Manager collaborates with other departments (including Clinical Staff, Administration, Directors, Managers, and others), to evaluate and coordinate activities and programs in support of delivery of patient care.  The Manager directs daily team operations and provides strong leadership through training, coaching, teaching, and managing assigned teams and departments.
Your Benefits:

Work with an exceptional organization focused exclusively on promoting the health care and quality of life for its members.  The forward-looking health plan has a demonstrated passion for finding innovative ways to enhance member’s ability to manage their own health.

Your Background: 
Valid, unrestricted state Registered Nurse (R.N.) license and BSN; Master’s degree in healthcare related field preferred.
Roughly 3-6 years of recent acute care clinical nursing experience.
Minimum of 3-5 year’s Case Management experience; Certified Case Manager (CCM) preferred.
Around 2-3 year’s managerial experience and leadership of a Case Management staff within a managed care or hospital environment.  
Prefer 5 or more years of case management experience, ideally with a strong acute care CM background with more recent managed care CM experience.
Familiarity with Medicaid managed care practices and policies, CHIP, and SCHIP.
Ability to analyze and integrate information and make sound decisions based upon established guidelines.
Resourcefulness as demonstrated by the effective application of professional knowledge to new situations. Possess planning, organizing, conflict resolution, negotiating and interpersonal skills.
Experience in training / teaching staffs to meet operational requirements and goals.
Strong oral and written communication skills; ability to interact with all levels of internal and external contacts.
Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.

Your Duties:
Provides clinical guidance and supervision to all case management programs, based on accepted principles of nursing, social work, gerontology, geriatrics and case management practice.  Provides clinical perspective and best practices to staff through one-on-one coaching, group interaction, and at in-service training or other team meetings. 
Manages a staff and monitors department activities to evaluate the productivity and quality of programs and processes in order to identify potential improvements and to ensure maximum performance.  Develops, manages and participates in departmental projects, workflow processes, policies and procedures in collaboration with internal and external stakeholders.  Ensures availability of specialized expertise to HCS programs by identifying case management needs and identifying and training subject matter experts.  Develops and maintains professional networks and individual relationships with hospitals, physicians, and other providers in order to promote continuity and quality of care.  Collaborates with staff and leadership to develop and implement systems that support operations and business goals within identified areas of responsibility.  Maintains professional and clinical relationships with Medical Directors, AMDs, UM Manager, and the Director of Healthcare Delivery; regularly discussing any concerns regarding utilization of services or complicated cases.  Uses a collaborative approach with the case management team in order to revise, develop, and implement cost savings methodologies and interventions.  Facilitates communication with providers to ensure continuity of care and coordination between multiple specialists, providers, and vendors.   Enhances clinical quality of networked medical groups and their attendance to SNP requirements by training medical group staffs upon request. 
Recommends and participates in departmental policy and procedure development; and participates in internal and external committee meetings, such as the Quality Assurance Committee and the Joint Operating Committee.  Acts as a resource and provides expert clinical opinions to all areas within the organization.  Maintains continuous telephonic availability, all day every day, for all hospitals, physicians, and providers to ensure that health plan members are appropriately moved through the continuum of care.  The manager will ensure that policies and procedures are developed and enforced in alignment with the standards of patient care and regulatory bodies and that the core components of the case management process are followed.

Rafik Henderson
CareNational Healthcare Services
480.646.3544 (CALL – TEXT – FAX)
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