Job Description

Job Location: Main Office - Santa Barbara, CA 93110
Position Type: Full Time
Salary Range: $120,970.00 - $181,455.00 Salary/year
Job Category: Care ManagementCentral Coast
Salary Range: $120,970 - $181,455
​​​​​​​Candidates for this position must reside on the Central Coast (Ventura, Santa Barbara, San Luis Obispo, Monterey, and Santa Cruz Counties) or be willing to relocate to the area upon hire. As a community-facing role, a local presence is essential to effectively engage with and serve our community. Please note that relocation assistance may be available.
Job

Summary
The Care Management (CM) Manager is responsible for overseeing the planning, organization, and management of daily operations within the Care Management Department. This role provides leadership, direction, and support to the team. The CM Manager ensures that program descriptions, policies, and procedures are current, participates in special assignments, audits, and focused projects, and performs other related tasks as assigned. The Care Management department is primarily made up of licensed registered nurses, master's-level social workers, clinical psychologists, and clinical support staff.
Duties and Responsibilities
- Plan, develop, and oversee Care Management (CM) activities in alignment with Department of Health Care Services and NCQA requirements.
- Contribute to the development and implementation of effective standards, policies, protocols, processes, and reports.
- Participate in both internal and external audits.
- Collaborate with Enhanced Care Management and Care Connect programs to ensure continuity of care for members transitioning into or out of Care Management.Analyze and prepare periodic reports on assigned CM activities.
- Conduct ongoing internal and community education on Care Management services
- Assess the effectiveness of health plan-wide CM activities.
- Identify and address process issues related to CM activities, that may create barriers to Member access, understanding or continuity of care.
- Serve as a subject matter expert in CM-related activities, advocating for Member center approaches and equitable access to services.
- Collaborate with IT to develop electronic health records, functionality, and reporting systems.
- Provide guidance to providers and members regarding timely requests, authorization requirements, and related matters.
- Act as the liaison between providers community organizations, and internal teams to support comprehensive coordinated care .
- Serve as a liaison to internal and external customers to ensure prompt resolution of Care Management and Care Coordination issues.
- Contribute input for projects and programs within the Health Services  Department.
- Ensure the unit meets all departmental, regulatory, and contractual compliance requirements.
- Monitor staff productivity and compliance with established standards.
- Participate in agency committees.
- Perform other duties as assigned.

QualificationsKnowledge/Skills/Abilities
Required:
- In-depth knowledge of current managed care principles and health plan regulatory requirements as they apply to the assigned unit.
- Ability to collaborate effectively with both internal and external customers.
- Strong skills in planning, directing, and coordinating activities for a large team of direct reports and staff.
- Capable of mentoring and supporting the development of leads and supervisors.
- Able to mentor and provide guidance to underperforming staff members.
- Demonstrates leadership by initiating activities, communication, and projects.
- Proficient in preparing accurate records and reports in a timely manner.
- Excellent verbal and written communication skills, including strong presentation abilities.
- Proficient in using Microsoft Word, Excel, Outlook, and PowerPoint.
- Depending on the unit assignment, knowledgeable of Utilization Management (UM) or Care Management (CM) standards of practice and their relevance to health plan activities.
Preferred:
- Must have a strong understanding of quality standards and state regulations applicable to a Medi-Cal health plan.
- When assigned to Utilization Management (UM), must be knowledgeable in InterQual or MCG clinical guidelines.
Education and Experience
- Current California RN license required, along with a Master’s degree, preferably in social work or clinical psychology, or equivalent clinical education, licensure, or certification.
- Bachelor’s degree required; Master’s degree preferred.
- Two to three (2-3) years of experience in Care/Care Management within a health plan, hospital, or similar setting.
- Five (5) years of medical management experience in a managed care environment, with at least two (2) years in a supervisory or higher role, which may substitute for a Bachelor’s degree.
- At least three (3) years of experience in a managed care setting focused on medical management; Medi-Cal managed care experience preferred.
- A minimum of two to three (2-3) years of experience in a supervisory role or as a charge nurse is required.