Care Manager

Community Health Plan of Imperial Valley; Oregon; Hybrid; USD 85,000 - 125,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

401k plan

Job summary

Community Health Plan of Imperial Valley is seeking a Care Manager to lead a team of Care Coordinators responsible for case management, health management, and transition of care activities for Imperial County members.

The role requires an active California RN license, 3+ years leading care coordinators, and strong knowledge of managed care. You will ensure regulatory compliance, collaborate with the healthcare team, and manage resources to improve member outcomes.

Qualifications

• Active California RN license without restriction.
• Minimum 3 years leading care coordinators.
• 3+ years in management, case management, disease management, or managed care.
• Knowledge of managed care principles with emphasis in care management/coordination.
• Clinical knowledge and critical thinking to assess whole-person care needs.
• Proficiency with Outlook, Word, Excel and case management programs.
• Experience partnering with healthcare team members.

Responsibilities

• Provide direction and guidance to the care coordination team to implement model of care and regulatory requirements.
• Manage caseloads for the team considering medical/psychosocial needs.
• Maintain electronic case management documentation in HIPAA-compliant systems.
• Complete training requirements and implement changes.
• Promote multidisciplinary collaboration and engagement of family and caregivers.
• Audit case management assessments and care plan development for timeliness and completeness.
• Monitor TOC assessments and contact timeframes per TOC protocols.
• Participate in audits (remote or onsite).
• Create business requirement documents and training materials.
• Assist with care coordination for resources and services for members.

Skills

Team leadership

Care coordination

Managed care knowledge

Nursing clinical judgment

HIPAA compliance

Outlook/Word/Excel

Interdisciplinary collaboration

Education

CA RN license

Tools

Case management software

Job description

Community Health Plan of Imperial Valley (CHPIV) is Imperial County's Medi-Cal managed care plan. We are a locally managed public health care plan committed to working with members, providers, and the residents of Imperial County. As we continue to build something great, we are looking for Care Managers to lead a team of Care Coordinators (CC's) responsible for case management, health management, and transition of care activities to assist members with their healthcare needs.

Responsibilities

• Provide direction and guidance to the care coordination team to ensure implementation of activities that align with the model of care and that meet all regulatory requirements
• Manage caseloads for the team appropriately with regard to complexity of medical or psychosocial needs (RN, LVN, LSW, other allied fields).
• Maintain electronic case management documentation system in compliance with standard processes, standard documentation styles, and HIPAA.
• Complete all training requirements and implement changes.
• Promote multidisciplinary collaboration, provider outreach, and engagement of family and caregivers to enhance the continuity of care for members.
• Audit case management assessments and care plan development for completeness and timeliness according to state requirements.
• Monitor the completeness of the Transition of Care (TOC) assessment and the timeframes for contact per TOC protocols.
• Actively participates in required internal and external audits either remote or onsite
• Create business requirement documents, user training materials and other related documentation
• Assist with care coordination for appropriate resources and services for members.

Qualifications

• An active California Registered Nurse License without restriction
• A minimum of 3 years leading Care Coordinators
• 3 or more years in management, case management, disease management, managed care in medical or behavioral health settings.
• Knowledge of managed care principles and practices with emphasis in Care Management and/or Care Coordination.
• Clinical knowledge and critical thinking skills with the ability to assess individualized whole-person care needs necessary to develop an effective care plan.
• Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs.
• Experience partnering with multiple members of a healthcare team both internally and externally.

Benefits

• A competitive salary of $85,000-$125,000/ year
• Health, dental, and vision insurance
• Paid time off
• A 401k plan with a generous match
• A chance to make a real difference in the Imperial Valley community

Preference will be given to candidates who are local to Imperial, California, but remote candidates living in California will also be considered.

We are an equal-opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.