Complex Case Management Manager - Pediatric

Profile

We have an opportunity to join the Alliance as the Complex Case Management Manager - Pediatric leading in the Utilization Management Department.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Utilization Management Director you will manage and lead the Pediatric Complex Case Management Unit, develop and adapt the Pediatric Case Management program to address needs, act as a subject matter expert and provide guidance related to care coordination and case management activities. You will provide management oversight related to Pediatric Complex Case Management functions and departmental operations. You will perform program effectiveness evaluation and manage, supervise, mentor and train assigned staff. You will collaborate with a variety of Alliance staff on special projects.

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here

Knowledge of:

Principles and practices of clinical nursing

Principles and practices of case management

Principles and practices of supervision and training

Principles and practices of care management, coordination, and utilization management

Principles and practices of managed care

CCS and the regulatory requirements related to CCS and the WCM program

Knox Keen, Medi-Cal, Title 22, and related regulations

Ability to:

Train, mentor, supervise and evaluate the work of staff, promote an atmosphere of teamwork, cooperation, and motivate staff to achieve goals and objectives

Organize and prioritize the work of others, delegate effectively, and follow up on work assignments

Act as a technical resource and explain regulations, processes, and programs related to are of assignment

Manage the development and implementation of projects, systems, programs, policies and procedures

Analyze and interpret legal, regulatory and contractual language, policies, procedures and guidelines, and legislative and regulatory directives

Provide leadership, facilitate meetings, and attend in person meetings with community partners, providers, and hospitals

Clear communicate findings of Care Coordination and Case Management reports to providers

Education and Experience:

Current and unrestricted license as a Registered Nurse issued by the state of California

Bachelor’s degree in Nursing and a minimum of six years of experience in a health plan or patient care setting, which included a minimum of two years of experience supervising and training a multi-disciplinary health care team, two years of pediatric case management experience, and some experience in a care management capacity (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying

OTHER DETAILS

While this position is connected to one of our Alliance offices, we are in hybrid telecommute work environment right now and we anticipate that the interview process will take place remotely.

Our Alliance office locations have officially re-opened as of May 2, 2022 and while some employees may work in full-time telecommute schedules, attendance at quarterly company-wide events or department meetings will be expected.

Based on the nature of work, this position may require onsite presence, which is dependent on business need. Details about this can be reviewed during the interview process.

COVID-19 Vaccine Requirement:

This position requires staff to be fully vaccinated and boosted upon their start date as a condition of employment. Proof of vaccination must be submitted at time of hire. Fully vaccinated and boosted is defined as receipt of the second dose in a 2-dose series (Pfizer & Moderna vaccines) OR receipt of a single-dose vaccine (Johnson & Johnson); AND receipt of the booster (if eligible); AND a 2-week period having passed since the administration of the last vaccine dose.

Additionally, all positions at the Alliance are required to meet these minimum qualifications.

OUR BENEFITS

Medical, Dental and Vision Plans

Ample Paid Time Off

11 Paid Holidays per year

401(a) Retirement Plan

457 Deferred Compensation Plan

Robust Health and Wellness Program

EV Charging Stations

And many more

ABOUT US

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Merced, Monterey and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet

At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

Company info

Central California Alliance for Health
Website : http://www.ccah-alliance.org/