Care Manager

Community Health Plan of Imperial Valley; Sacramento (CA); Remoto; USD 85.000 - 125.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health, dental, and vision insurance

Paid time off

401k with generous match

Descrizione del lavoro

Community Health Plan of Imperial Valley (CHPIV) is Imperial County's Medi-Cal managed care plan. We are seeking a skilled leader to guide the care coordination team, manage caseloads, and ensure regulatory compliance across all case management activities.

The ideal candidate will hold a California RN license, have 3+ years leading care coordinators, and strong knowledge of managed care. Remote options are available for CA residents, with a competitive salary and excellent benefits.

Competenze

• Active California RN license without restrictions.
• Minimum 3 years leading care coordinators.
• 3+ years in management, case management, or care coordination in medical/behavioral health.
• Knowledge of managed care principles and practices.
• Clinical knowledge to assess whole-person care needs and develop care plans.
• Proficient in Outlook, Word, Excel and case management software.
• Experience collaborating with internal and external healthcare teams.

Mansioni

• Provide direction and guidance to the care coordination team to ensure model-of-care implementation and regulatory compliance.
• Manage caseloads for the team considering medical or psychosocial complexity.
• Maintain electronic case management documentation compliant with HIPAA and standard processes.
• Complete trainings and implement required changes.
• Promote multidisciplinary collaboration and provider engagement to improve continuity of care for members.
• Audit case management assessments and care plan development for timeliness and completeness.
• Monitor TOC assessments and contact timelines per TOC protocols.
• Participate in internal and external audits (remote or onsite).
• Create business requirement docs, user training materials and related documentation.
• Assist with care coordination for appropriate resources and services for members.

Conoscenze

Leadership

Care coordination

Critical thinking

Team collaboration

Communication

Formazione

California RN License

Strumenti

Outlook

Word

Excel

Case management software

Descrizione del lavoro

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.

Our next team member will do the following:

• 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

You may be right for this job if you have the following:

• 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

Our commitment to you:

• 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.