Compensation and Benefits Lead Manager

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Job Description

Regional Director Care Coordination and Case Management - SO CAL

RELOCATION package - AMAZING benefits and career track!

This is a Southern California regional position and will be responsible for the overall design, care, delivery model, coordination, management and continuous quality improvement of the commercial, federal and state mandated care coordination case management and care transition programs - Medicare, Medi-Cal, Special Needs. Local travel.

• Lead a department with 30+ frontline staff providing care coordination / case management to members across the region
• Provides oversight and integration of overall operations (fiscal, human resources, and competency) for all programs.
• Assists the Executive Director in providing strategic leadership to ensure efficient utilization of resources and the delivery of quality, cost effective, efficient health care to meet established goals, objectives, policies, and regulatory requirements.
• Monitors and assesses trends and best practices in care coordination, complex case management, care transitions, and makes recommendations to develop/adjust strategies, programs, and service delivery to meet changing business and market conditions.
• Partners with continuum leaders to ensure seamless transition of members
• Partners with leaders across the enterprise on enterprise initiatives
• Directs, staffs and organizes the care coordination / case management and care transition programs across the region. Continually evaluates and improves the quality of the care and services provided.
• Designs, plans, and implements an effective, efficient, and quality model of care to provide for the needs of members, physicians, and personnel.
• Establishes appropriate program goals and objectives and related metrics to measure the effectiveness of the program.
• Develops, monitors, and controls payroll, non-payroll and capital budgets and expenditures for all programs.
• Monitors operational and financial reports and implements improvement plans as required.
• Ensures the development and implementation of care coordination / case management and care transition policies and procedures.
• Ensures ongoing education and competence measurement of care coordination / case management and care transition personnel.
• Makes hiring decisions, takes disciplinary action, and conducts performance assessments for assigned staff.
• Participates in committees and/or projects.
• Collaborates effectively with internal and external stakeholders to ensure the effectiveness and efficiency of the programs.
• Performs other duties as assigned.

Qualifications

Qualifications:

• Minimum five (5) years of nursing experience in a clinical setting required.
• Minimum four (4) years of management experience in health plan/hospital/Case Management required.
  
  
• Bachelors degree in nursing, healthcare or business-related field.
• Graduate of an accredited school of nursing.
  
  
• Registered Nurse License (California) required at hire
  
  

Additional Requirements:

• Knowledge and expertise in case management scope of practice, technique and community resources.
• Demonstrated knowledge of case management, discharge planning, transition of care, transfer coordination; Medicare, Medicaid, Title 22, NCQA, JCAHO, URAC, and other federal/state/local regulations.
• Skilled collaborator and team builder.
• Ability in planning, organizing, conflict resolution, negotiating and interpersonal skills.
• Knowledge regarding compliance requirements by the various regulatory agencies and various legislative directives affecting health care management and reimbursement.
• Excellent communication skills, good problem-solving skills, and decision-making skills; PC skills to include Microsoft word, excel, power point, and electronic medical record.
• Strong customer service orientation required.

Preferred :

• Masters degree in nursing, healthcare or business-related field.
• Case Management Certification.