Senior Manager, Care Management

Senior Manager, Care Management Reporting to the Director, Care Management, the Senior Manager, Care Management is responsible for the operation of the Care Management (CM) team, large‑scale care management initiatives, managing staff, and oversight of functions. You will lead the development of department policies and processes, ensuring that you document all workflows with a focus on continual quality improvement. They also oversee regulatory audits and respond to inquiries related to departmental services. The Senior Manager builds a high‑performing team of Clinical Supervisors, Care Management Nurses and Coordinators committed to providing service and ensuring the delivery of high‑quality care to our members. Salary: $170,000 - $182,000 per year What You Will Do Oversight the performance of the Care Management team, including the direction, planning, implementation and continuous improvement of all care management activities. Provide direct oversight and guidance to the Clinical Supervisors and other staff as needed, thereby creating a high‑performing team. Escalate issues for clinical and operational issues from staff, members and providers. Model data‑driven quality improvement as it applies to Care Management programs and large‑scale initiatives. Understand and execute regulatory requirements for Care Management programs by all governing bodies, including DHCS, DMHC and NCQA, encompassing responsibility for audit preparation presentations and follow up. Responsible for development and updates to multiple policy and procedures, desktop procedures, workflows and department documents. Guide collaboration through participation in Care Management and enterprise‑wide initiatives. Ensure the quality of ongoing education provided to the CM staff. Responsible for Care Management program metrics and annual goals, at the organizational level and at the individual staff level. Analyze business processes, systems, and data to identify areas for improvement and new opportunities. Prepare reports on Care Management activities according to established schedules and format. Identify patterns and trends and, in collaboration with the Director, develop and implement corrective action plans, where necessary. Develop partnerships with peer functional leaders from other teams to help maximize company resources and deliver positive outcomes. Responsible for department budgetary resources, including bonus allocation in a pay‑for performance plan. Collaborate with the Health Services Product Management and Business Analytics teams to update and monitor the CM dashboards monthly, while analyzing and reporting overall trends to the Director. Provide clinical leadership and expertise when needed across the Health Services department and health plan as a whole. Ensure the privacy and security of PHI (Protected Health Information) as outlined in SFHP's policies and procedures relating to HIPAA compliance. Monitor workload including making recommendations for budgetary purposes. Develop and implement staff hiring and retention strategy in collaboration with the Clinical Supervisors. Ensure that the care management system is being optimized to support new and evolving programs. Cross train all department programs to ensure they can provide coverage and address operational gaps as needed. What You Will Bring Registered Nurse or Licensed Mental Health Clinician (LCSW, LMFT) with 3+ years of care management experience within a managed care setting Bachelor's degree in a related area required; Masters degree preferred Demonstrated leadership experience with 3 years of experience in a supervisory or team lead role Bi‑lingual Spanish or Cantonese, desirable but not required Experience with Care Management program development and evaluation Knowledge of and experience with state and federal insurance programs preferred What We Offer Medical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP. Dental: You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage. Vision: Employee vision care coverage is available through Vision Service Plan (VSP). Retirement – Employer‑matched CalPERS Pension and 401(a) plans, 457 Plan. Time off – 23 days of Paid Time Off (PTO) and 13 paid holidays. Professional development: Opportunities for tuition reimbursement, professional license/membership. San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. San Francisco Health Plan is an E-Verify participating employer. Hiring priority will be given to candidates residing in the San Francisco Bay Area and California. #J-18808-Ljbffr San Francisco Health Plan