Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
The Manager, Care Management is directly responsible for the oversight and monitoring of care management functions, organization, direction and staffing of L.A. Care's Case Management function(s) including but not limited to Complex Case Management/Case Management, Care Coordination and Special Programs Outreach. Responsibility includes regulatory compliance, accreditation compliance, oversight of Plan Partners' and Delegated Provider Groups related operations, oversight of care management related delegated functions, operations for direct lines of business and/or management services agreement functions, and interfacing with external agencies including other Local Initiatives, Plan Partners and external organizations. The Manager, Case Management is further responsible to assure all functions are operating in accordance with the organization's mission, values and strategic goals and are provided in a manner that is responsive and sensitive to the needs of L.A. Care's culturally diverse membership.
General Essential functions: Responsible for the ensuring overall staff management and operational functions associated with the Care Management department. Functions include Complex Case Management, Case Management, Care Coordination, and Special Programs (i.e. CCS, Regional Center) functions. Assures departmental compliance with: All contracts (i.e. CMS, DHCS, Covered California, PASC-SEIU, First 5LA, etc.), DMHC regulations, applicable state and federal regulations, Management Services Agreements & Other Contracts. Oversees and monitors operational compliance with organizational standards, policies and procedures and regulatory requirements. Assures department meets all regulatory time frames on CM. Develops and implements departmental policies and procedures. Develops and maintains departmental statistical and performance reports. Develops, implements and monitors performance standards. Develops and maintains effective communication mechanisms at various levels of the organization and with external organizations. Develop and maintain departmental budgets in line with organizational goals. Ensuring the maintenance of positive relationships between Plan Partners and PPGs. Identifies and implements, with approval, programs that improve the provision of services to members. Directs measurement and analysis of Plan Partner and delegated PPG functions. Assures completion of ongoing monitoring, audits, corrective action plan and necessary follow-up. Facilitates communication to and involvement of Plan Partners. Assures appropriate communication and coordination with CBOs and other external agencies. Facilitates data flow, analyzes, reports, design formats, interprets data and recommends alternatives/solutions internally and externally. Requests assistance from Director as needed to accomplish goals.
Maintains confidentiality in compliance with all HIPAA requirements. Communicates to supervisors any barriers to completing assignments or daily work in an efficient and effective manner. Demonstrates reliability and good attendance and punctuality standards.
Human Resource Management: Daily staff supervision and oversight. Develops and maintains a culturally sensitive work environment that promotes staff growth and education. Completes performance appraisals in accordance with established policies and based upon achievement of the L.A. Care mission, value, objectives and management expectations. Assures staff have access to appropriate training and educational opportunities. Recruits appropriately qualified candidates, with approval of Director. Counsels and coaches staff in consultation with Director and in conjunction with HR. Participates in the hiring and termination of staff with Director and in conjunction with HR.
In conjunction with Director of CM, responsible for oversight and adequate performance of direct line of business PPG delegated activities. Develops and sustains active communications with PPGs. Identifies performance issues or opportunities for improvement within PPG UM operations that impact compliance. Collaborates with Oversight Staff on identifying topics and agenda items for the PPG trainings/JOMs.
Performs other duties as assigned.
Master's Degree in Social Work
In lieu of degree, equivalent education and/or experience may be considered.
Bachelor's Degree in Nursing
At least 4 years of recent care management experience in a hospital or managed care setting, such as a health insurance environment and/or experience as care manager in home health or hospice environments.
At least 3-5 years of management/supervisory experience and relevant health plan experience.
Experience with Medi-Cal and Medicare populations and regulatory requirements.
Experience with Medi-Cal, under-served and culturally diverse populations.
Experience with state Medi-Cal regulations.
Excellent verbal and written communication skills.
Strong problem solving, planning, and organizational skills.
Active & Current Driver's License, with a clean record and Auto Insurance Required
Licensed Clinical Social Worker (LCSW) - Active, current and unrestricted California License
Registered Nurse (RN) - Active, current and unrestricted California License
Please note that a Licensed Clinical Social Worker is only required when Master's Degree in Social Work. Licensed Clinical Social Worker not required with Associate's or Bachelor's Degree in Nursing.
L.A. Care offers a wide range of benefits including
Nearest Major Market: Los Angeles
Job Segment: Medical, Clinic, Medicare, Palliative, Hospice, Healthcare