Case Management Program Manager

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

Salary Range: $113,836 - $176,446

The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change.

FLSA Status: Exempt

Department: Health Services

Reports To: Director, Case Management

General Description Of Position

The Case Management Program Manager is responsible for management of both ongoing and short-term projects, staff and vendor training and technical systems management for all care coordination staff. The Case Management Program Manager works collaboratively and cross-functionally with internal and external stakeholders to ensure that Case Management workflows, systems and reporting are in compliance with State and Federal regulations and that staff, delegates, and vendors are performing those functions. The Case Management Program Manager serves as the subject matter expert and lead on IT projects related to case management including system updates, transitions, and maintenance of care management software programs. The Case Management Program Manager is responsible for developing work plans, gap analyses, survey readiness, and facilitating stakeholder collaboration for all projects assigned, including ongoing program planning and work stream facilitation.

Essential Duties And Responsibilities

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.

• Lead and facilitate both new and ongoing projects that support the Case Management program. Provide direction for project framing, work plan development, business case analysis, user-testing, implementation, and outcome measurement.
• Collaborate with Information Technology (IT) teams to execute systems projects including case management platform updates, transitions, and maintenance.
• Develop and implement new and ongoing training for all care coordination staff as aligned with State and Federal regulations, policies, procedures, and workflows.
• Provide strong oversight and regular auditing and monitoring activities to ensure care management guidelines are followed.
• Monitor and track changes in regulatory requirements and develop and implement updates to ensure case management systems are in compliance with State and Federal regulations.
• Collaborate with other Health Services departments including Quality, Utilization Management, and Pharmacy to ensure department and organizational goals are met.
• Develop and maintain all appropriate documentation, including timelines, project scope, decision logs and work plans, including the development of process documents such as process maps, workflows, and desktop procedures.
• Monitor timeliness of projects, cost management, and resource usage to ensure completion and implementation of project and budget variances.
• Identify, research, and resolve project issues and elevate critical issues, problems, and delays to management and executive leadership, as needed.
• Conduct studies of operations, workflows, and fact gathering sessions with stakeholders to document, quantify, and specify process improvement efforts. Work with internal stakeholders and business leaders to identify the gap between current and desired results.
• Develop and distribute timely project communications and status updates.
• Participate in meetings and conference calls with regulatory agencies (i.e. Federal, State and County), National Committee for Quality Assurance (NCQA), SCFHP management, delegates and vendors to obtain and capture requirements and timelines.
• Perform other related duties as required or assigned.

REQUIREMENTS – Required (R) Desired (D)

The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

• Bachelor’s Degree in Management, Healthcare, Business or Information Technology, or related field, or equivalent experience, training, or coursework. (R)
• Minimum two years of experience serving vulnerable members of the community. (R)
• Minimum two years of experience managing, implementing and directing community programs. (D)
• Demonstrated knowledge of Medicare and Medi-Cal benefits, Centers for Medicare and Medicaid Services (CMS), Department of Health Care Services (DHCS) and Department of Managed Health Care (DMHC) regulations. (R)
• Knowledge of local health care community including medical, housing, behavioral health, and social services. (D)
• Superior communication skills and ability to effectively facilitate meetings and deliver information/presentations. (R)
• Strong organizational skills; able to adapt to changing environment, work independently, and manage multi-task responsibilities. (R)
• Ability to work with a high level of independence with strong collaboration and relationship management skills. (R)
• Strong analytical and problem solving abilities. (R)
• Ability to direct and manage large-scale, complex, cross-functional, multi-departmental projects to completion with minimum supervision, (R)
• Ability to understand, interpret, and apply applicable rules and regulations, and establish and evaluate priorities. (R)
• Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as such as MS Word, Excel, Power Point, Visio, Project and Outlook. (R)
• Ability to use a keyboard with moderate speed and a high level of accuracy. (R)
• Ability to express oneself clearly and concisely when interacting with internal and external stakeholders over the telephone, in person or in writing. (R)
• Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R)
• Ability to take initiative and exercise good judgment when making decisions within the scope of the position. (R)
• Ability to maintain confidentiality. (R)
• Ability to comply with all SCFHP policies and procedures. (R)
• Ability to perform the job safely with respect to others, to property, and to individual safety. (R)

WORKING CONDITIONS

Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to regular contact with co-workers, managers, external partners, and vendors, in person, by telephone, and via work-related electronic communications.

Physical Requirements

Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation.

• Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R)
• Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R)
• Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R)
• Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R)
• Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R)
• Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person, by telephone, and electronically, throughout a typical workday; attention to detail. (R)

ENVIRONMENTAL CONDITIONS

Add sentence to describe the environmental conditions.

EOE