santa clara family health plan
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Supervisor, Case Management
at santa clara family health plan
Job Reference #: 779
Santa Clara Family Health Plan - San Jose, CA 95119
# of Openings:
FLSA Status: Exempt
Department: Health Services
Reports To: Manager, Case Management
GENERAL DESCRIPTION OF POSITION
The Supervisor of Case Management is responsible for the oversight of daily operations of case management activities, providing assistance with the development and implementation of new programs and related workflows, coordinating case management referrals for all lines of business, and serving as a resource for internal departments, members, providers, delegates and community partners. In addition, the Supervisor of Case Management is responsible for supervising Case Managers and Personal Care Coordinators to ensure that all case management functions are performed accurately and efficiently and in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and business requirements.
ESSENTIAL DUTIES AND RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily.
1. Develop, implement and supervise case management workflows in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures and business requirements for all lines of business.
2. Monitor and provide continuous quality improvement to the processes of basic, specialty and complex case management, including timely completion of Health Risk Assessments (HRA), documented development of member care teams, development and monitoring of Individual Care Plans (ICP) and changes to members’ risk stratification after time of enrollment.
3. Collaborate with the Manager of Case Management with routine and ad hoc audits and the development, implementation and monitoring of corrective action plans.
4. Ensure the integration of Case Management operations into other internal and external teams/departments including Long Term Services and Supports and Behavioral Health.
5. Collaborate with the Manager of Case Management with the oversight and assignment of RN Case Manager, Medical Management Coordinator and Personal Care Coordinator caseloads across various case management programs.
6. Resolve or facilitate resolution of problematic and/or complex issues by escalating to appropriate management/leadership person.
7. Establish and maintain effective interpersonal relationships with staff at all levels, members and/or their authorized representatives, providers, other program or agency representatives.
8. Attend off site meetings or events as necessary.
9. Perform other related duties as required or assigned.
Carries out supervisory/management responsibilities in accordance with the organization’s policies, procedures, applicable regulations and laws. Responsibilities include:
1. Recruiting, interviewing, and hiring.
2. Developing a high performing department culture and staff. This includes setting the standard for staff/peers and motivating employees to maximize organizational goals and objectives.
3. Effectively assimilating, training and mentoring staff and (when appropriate), cross training existing staff and initiating retraining. This includes coaching to help increase skills, knowledge and (if applicable) improve performance.
4. Setting goals and planning, assigning, and directing work consistent with said goals. This includes responding to employees’ needs, ensuring they have the necessary resources to do their work.
5. Appraising performance, rewarding and disciplining employees, addressing complaints and resolving issues. This includes providing regular and effective feedback to employees and completing timely and objective performance reviews.
REQUIREMENTS – Required (R) Desired (D)
The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.
1. Unrestricted professional clinical licensure in state of California. (R)
2. Minimum two years of progressively responsible experience in a supervisory or lead capacity in case management, utilization management, discharge planning and/or quality improvement in a managed care setting. (R)
3. Current working knowledge of Medicare and/or MediCal regulations and NCQA Population Health standards. (R)
4. CMSA Certification in Case Management. (D)
5. Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R)
6. Spanish, Vietnamese, Chines, or Tagalog language bi-lingual skills. (D)
7. Ability to consistently meet accuracy and timeline requirements to maintain regulatory requirements.
8. Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs. (R)
9. Ability to use a keyboard with moderate speed and high level of accuracy. (R)
10. Excellent communication skills including the ability to express onceself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing. (R)
11. Ability to think and work effectively under pressure and accuracy prioritize and complete tasks within established timeframes. (R)
12. Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R)
13. Ability to comply with all SCFHP policies and procedures. (R)
14. Ability to perform and job safely and within respect to other, to property and to individual safety. (R)
Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:
1. Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R)
2. Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R)
3. Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R)
4. Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R)
5. Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R)
6. Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R)
General office conditions. May be exposed to moderate noise levels.