Your Role
The Care management team is looking for a leader with Medi-Cal experience who can help design and lead our Medi-Cal line of business. The Senior Manager of Care Management, Medi-Cal will report to the Director of Care Management in the Population Health Department In this role you will be will serve as the professional leader of registered nurses within Blue Shield care management who is a good collaborator, experienced in people leadership, and will serve as a mentor and advisor to senior leadership. The selected candidate will also function as the subject matter expert on professional nursing/ care management for Medi-Cal regulations- who will represent care management in initiatives, client presentations, act as a liaison between other business units within Blue Shield to bolster care management knowledge on community resources, best practices, and promote holistic and integrated approach to medical care management Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Work
Your Work
In this role, you will:
- Establish operational objectives for department or functional area and participates and leads other managers to establish group objectives
- Be responsible for team, department or functional area results in terms of planning, cost and methods in collaboration with Director
- Participate in the development and implementation of the annual budget under the direction of Director
- Ensure workflow procedures and guidelines are clearly documented and communicated
- Interpret or initiate changes in guidelines/policies/procedures
- Provides leadership to ensure best utilization of resources in obtaining organizational goals, regulatory compliance, adhering to corporate policies through oversight of daily operations, assessment of adequacy of staffing, and adherence to standard of social workers
- Enhancement or creation of care management processes in compliance with regulatory requirements
- Maintenance and operationalizing of the Model of Care (MOC) for Medi-Cal SPD members, Cal-AIM, and other contracts with DHCS and CMS in close collaboration with and guidance from Director of Care Management
- Responsible for ensuring that the care management department readiness for internal and external regulatory and accreditation audits
- Primary involvement with committees, projects, initiatives, professional associations, and other service providers to promote appropriate and cost-effective care delivery for the population
- Focused on services and programs to increase quality of life and health of all members
- Macro level collaboration and involvement with committees, projects, initiatives, community leaders, county social service personnel, professional associations, and other service providers to promote appropriate and cost-effective care delivery for the population
- Demonstrates a passion for leading positive change by enhancement and sustainment of an innovative care management program that advocates for patient safety by keeping informed of mandates, regulations, and best practice innovations
- Enhancement and development of client health education, Advance Healthcare Planning and End of Life counseling and support and promotes participation in staff, patient, and community education
- Promotion of best practice in impacting social determinants of health and homelessness
- Represent Blue Shield care management in Blue Shield sponsored community events and fairs
- Regular collaboration with other Blue Shield managers in care management and other business units
- Maintain daily measurement standards and outcomes for staff
- An active participant in practice transformation
Your Knowledge and Experience
- Requires a bachelor's degree or equivalent experience
- Requires a current CA RN License
- Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements
- Requires at least 10 years of prior relevant experience including 4 years of management experience gained as a team leader, supervisor, or project/program manager
- Requires health insurance/managed care experience (Commercial, Medicare, and Medi-Cal).
- Requires excellent communication, presentation, and procedure-writing skills
- Lean methodology desired
- Advanced degree preferred