Case Management Program Lead

Santa Clara Family Health Plan; San Jose (CA); On-site; USD 114,000 - 176,000; Full time

Job summary

Santa Clara Family Health Plan is seeking a Case Management Program Manager responsible for overseeing both ongoing and short-term projects, staff and vendor training, and IT systems management for care coordination staff.

You will collaborate with internal and external stakeholders to ensure workflows and reporting comply with state and federal regulations, serving as the SME and lead on IT projects related to case management.

Qualifications

• Bachelor’s degree in management, healthcare, business, IT, or related field.
• Minimum two years of experience serving vulnerable members.
• Knowledge of Medicare and Medi-Cal benefits, CMS, DHCS and DMHC regulations.
• Strong communication and meeting facilitation skills.
• Ability to manage multi-project portfolios and deadlines.
• Proficient with MS Word, Excel, PowerPoint, Visio, Project and Outlook.

Responsibilities

• Lead and guide new and ongoing Case Management projects from framing to outcome measurement.
• Collaborate with IT to implement system updates and maintenance.
• Develop and deliver training for care coordination staff.
• Monitor compliance with state and federal regulations.
• Coordinate with Quality, Utilization Management, and Pharmacy to meet goals.
• Document project plans, timelines, and decision logs.
• Track project timeliness, budget, and resource use.
• Identify and resolve project issues and escalate when needed.
• Prepare communications and status updates for stakeholders.
• Participate in meetings with regulatory agencies and NCQA.
• Perform other duties as required.

Skills

Project management

Staff training

Regulatory knowledge

Stakeholder collaboration

Communication skills

Analytical thinking

Problem solving

Education

Bachelor’s Degree in Management, Healthcare, Business or IT

Tools

MS Word

Excel

PowerPoint

Visio

Project

Outlook

Job description

Santa Clara Family Health Plan is seeking a Case Management Program Manager responsible for overseeing both ongoing and short-term projects, staff and vendor training, and IT systems management for care coordination staff.

You will collaborate with internal and external stakeholders to ensure workflows and reporting comply with state and federal regulations, serving as the SME and lead on IT projects related to case management.