Manager, Case Management (RN)

Job Number: 1391

Workplace Type:

Position Title: Care Coordination Manager

External Description:

Position Summary: 

The Manager of Care Coordination is responsible for oversight of healthcare management and coordination within the scope of licensure for members with complex and chronic care needs. The manager will collaborate with the case management team to ensure proper inpatient and outpatient care process, to assess, develop, implement, coordinate, monitor, and evaluate options and services to promote quality member health care across a continuum in order to achieve optimal member outcomes and ensure consistent, cost effective care that complies with Alignment policy and all state and federal regulations and guidelines.

Essential to the Manager of Care Coordination role is contributing to the success of the company. The manager’s actions should be poised toward business growth and comply with Alignment policies. The manager will collaborate with the department Director and upper management team to promote successful growth within the department and throughout the company.

This position is responsible for the day to day operational performance of an integrated health management team while ensuring high quality care management and adherence to regulatory and compliance standards for the appropriate program lines of business.

General Duties/Responsibilities:

(May include but are not limited to)

 

• Manages and leads the overall case management activities and day to day operations of the team.  Evaluates policies and workflows for efficiencies and makes necessary changes to diminish risk and enhance process improvements.
• Manages the design, development, implementation and maintenance of projects/process related to case management initiatives that may encompass multi departments.
• Collaborates with UM, CM, HEDIS/STARs and other AHP programs and departments to facilitate optimal program integration and continuity of care.
• Coordinates the development, revision and implementation of case management policies and procedures. Assures consistency in processes and function across teams. Recommends and implements changes as appropriate.
• Assures compliance with state and federal regulations, accreditation requirements, contract agreements, and performance guarantees and participates and/or leads with on-site audits, account and provider meetings.
• Directs or oversees appropriate routing or assignment of cases, monitors volume and complexity of cases to ensure balanced distribution of caseloads and adequate staffing.
• Collaborates with the AHP Trainer / Program Integrity manager in the administration of the CM program.
• Utilizes results to measure case manager performance. Provides staff, both individually and as a group, with regular timely feedback, coaching and training. Develops and implements corrective action or performance improvement plans as indicated.
• Conducts quality reviews. Reports audit results and identified opportunities for staff development and process improvements to designated management and committee
• Available and accessible to staff as a primary resource.  Acts as preceptor, subject matter expert, and provides coaching and mentoring for staff development and performance improvement.
• Coaches, mentors, and holds staff accountable to assure that department and performance goals and objectives are met. Conducts performance audits and manages personnel and performance issues according to AHP policies and procedures
• Ability to analyze data and recommend strategies for pilots, projects, and trends for case management initiatives.  Demonstrated ability to manage projects resulting in desired outcomes.

 

• Effectively communicates and keeps Director of Case Management informed of all departmental operations, activities, data, program and staff performance, issues or any other pertinent information.
• Ability to perform all functions within the Case Management department and acts as a working manager to support the team and new business initiatives as needed.
• Performs other duties as required in a competent, professional, and courteous manner.

 

 

Supervisory Responsibilities:

Oversees assigned staff. Responsibilities include: recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees.

 

Minimum Requirements:

 

1. Minimum Experience:
   1. 5 + years of clinical case management experience; or any combination of education and experience, which would provide an equivalent background.
   2. 2 + years supervisory experience in a health plan setting.
2. Education/Licensure:
   1. Current, Active and Unrestricted Registered Nursing license in the state in which you are applying; Case Management Certification preferred.
   2. BSN / MSN degree (preferred)
3. Other:
   1. Knowledge of Medicare Managed Care Plans
   2. Knowledge of MCG criteria/Utilization functions
   3. Demonstrated leadership skills
   4. Ability to manage projects/initiatives to improve program performance
   5. CCM preferred

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee may lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

 

FLSA Status: Exempt

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Manager, Case Management (RN)

Company Profile:

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].