PHM Manager of Case Management
Kern Health Systems
We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).
Our Mission.. Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.
**$2,000 RN Bonus
Under direction of the Kern Health Systems (KHS) Director of Population Health and DCMO the Manager of Case Management is responsible for supervising and directing the complex case management (CCM) activities specific to the Seniors and Persons with Disabilities (SPDs) and Medicaid populations. Complex case management within KHS is defined as the coordination of care and services for members who need help navigating the healthcare system to facilitate the appropriate delivery of care and services. These services are provided utilizing available resources across a continuum of care and in collaboration with members, caregivers, medical home providers, and ancillary health care providers.
Incumbent in this position is fully competent in all essential areas of supervising case management activities and is expected to use an advanced level of judgment in the management and mentoring of staff. The Case Management Manager works independently under general direction of the Director of the Department. This position involves frequent communication with Medical Directors, staff, and network providers telephonically, electronically and potentially in-person. Manager of Case Management is responsible for providing comprehensive assessment, planning, implementation and overall evaluation of individual patient needs for those identified individuals across the health plan.
SUPERVISES: Case Manager RN, MSW, and Case Management Assistants
MAJOR DUTIES & RESPONSIBILITIES:
- Works to maximize system and staff efficiencies
- Oversees development and refinement of the Care Management Program including Population Health, Disease Management and Complex programs; adds additional components when required by regulations/contracts or based on business need or value.
- Oversees readmission reduction programs (e.g. Care Transitions Program) including ongoing monitoring of metrics and cost saving
- Oversees provider-based care management programs
- Oversees the development, implementation, and delivery of interventions that will decrease the impact of social determinants on the health of the Plan’s population.
- Coordinates care with behavioral health team to provide seamless and integrated
- Develops and monitors statistics, trends and reports in order to implement process improvement strategies focused on efficiencies, effectiveness, productivity, and outcome
- Develops and implements an ongoing quality audit program in conjunction with the Quality Improvement department.
- Evaluates training needs of staff, and with managers and trainer, develops appropriate training.
- Is responsible to ensure that each staff member receives the appropriate supervision, and professional development. Directs managers to implement and carry out the related training tasks.
- Responsible for success and overall compliance of the Care Management department.
- Ensures that Care Management and Disease Management services support the achievement of the best health outcomes for members.
- Identifies opportunities to develop, implement and evaluate improvements in disease and population specific programs and interventions.
- Ensures all programs are compliant with state and federal requirements and works to implement modifications as necessary.
- Establish and meet appropriate benchmarks for department performance.
- Responsible for achieving KHS department initiative for medical cost management and NCQA accreditation.
- Works closely with the leadership of KHS to assure communication and operational integration within the Plan.
- Responsible for data reporting and operational metrics.
- Collaborates with internal department managers and directors in the planning, development and coordination of department specific and cross - functional initiatives as needed.
- Collaborates with key external provider partners in the planning, development and coordination of initiatives as needed
- Participates as a member of the KHS management team.
- Coordinates services between offices to provide consistent evidence-based and best practices services.
- Responsible for the overall Care Management Program Plan, updating annually
- Maintains overall responsibility for staff coverage and assignments related to case management activities.
- Provides direction and acts as resource to Case Management staff in terms of contract and benefit clarifications.
- Key clinical and operational liaison for Health Homes, Transitional Care Clinics, and Emergency Room Avoidance programs, and others as defined
- Evaluates staff performance and maintain timekeeping.
- Ensures that all processes within the department are implemented according to DHCS/DMHC requirements including case management reporting.
- Makes recommendations for changes to work processes in order to streamline department functions as needed.
- Facilitates information sharing and problem resolution by establishing cooperative relationships with KHS departments and staff, Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Department of Public Health, and Department of Mental Health
- Encourages staff in growth opportunities; in-services, seminars, etc.
- Develops a comprehensive orientation program for all new employee
- Participates as a Management clinical liaison in committees and workgroups as needed.
- Monitors staff performance in terms of timeliness of assessment contacts and opening cases
CORE COMPENTENCIES / KNOWLEDGE & SKILL REQUIREMENTS
- Lead by example to support a positive work environment that values patient advocacy, respectful listening, diverse expression of opinion and constructive conflict resolution;
- Adheres to KHS’s Code of Ethics and Business Conduct and all company policies; e.g., confidentiality, attendance, safety/security, use of equipment and technology, appearance and demeanor;
- Represent KHS in a positive manner to all members, caregivers, staff and external stakeholders;
- Demonstrate commitment to continuous improvement;
- Strong knowledge of acute chronic care nursing principles, methods and common treatments;
- Strong knowledge of common human diseases and usual and customary methods of treatments;
- Demonstrated knowledge of medical terminology;
- Ability to effectively evaluate medical records to determine appropriateness and necessity of care;
- Demonstrated knowledge of health care delivery systems;
- Very strong interpersonal skills, including the ability to establish and maintain effective working relationships with individual at all levels both inside and outside of KHS;
- Ability to use tact and diplomacy to diffuse emotional situations;
- Effective oral and written communication skills, including the ability to effectively explain complex information and document according to standards;
- Intermediate skills in Word and Excel with basic ability to enter data into and navigate through a database;
- Demonstrated ability to respect and maintain the confidentiality of all sensitive documents, records, discussions and other information generated in connection with activities conducted in, or related to, patient healthcare, KHS business or employee information and make no disclosure of such information except as required in the conduct of business;
- Demonstrated ability to commit to and facilitate an atmosphere of collaboration and team work;
- Self-directed, with proven ability to work independently with minimum supervision;
- Demonstrated ability to multi-task in an interrupt-driven environment and complete assignments on a timely basis;
- Strong attention to detail; work accurately and at a reasonable rate of speed;
- Compliant with KHS policies and procedures; performs the job safely and with respect to others, to property, and to individual safety.
- Performs other related duties and special projects as assigned.
EDUCATION, EXPERIENCE & TRAINING REQUIRED:
- Minimum of seven years (7) full-time clinical experience in acute care, community health setting, public health nursing or chronic disease management required;
- Experience working with patients and caregivers regarding self-care and disease management required;
- Experience working in case management or care coordination is a plus;
- Knowledge of Kern County Community resources for seniors and people with disabilities is a plus;
- Bachelor’s Degree in Nursing, Health Administration or related healthcare field preferred.
- California Nurse Practitioner license a plus;
- Registered Nurse with an active, current, unrestricted license
- Valid California Driver License Other: Possession of valid California Driver’s License and proof of valid State required auto liability insurance. Required Travel Up to 5%.
- Bilingual (English/Spanish) preferred
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.
Job Type: Full-time