Lead Clinical Care Manager

1 week ago

Rancho Cucamonga California, United States Inland Empire Health Plan Full time
Job Summary

We are seeking a highly skilled Clinical Care Manager - Behavioral Health and Case Management to join our team at Inland Empire Health Plan. As a key member of our care management team, you will play a vital role in developing and implementing high-risk member-centric care plans, ensuring regulatory standards are met, and promoting quality patient care outcomes.

Key Responsibilities:
  • Care Plan Development: Review care plans to ensure regulatory standards and member needs are met, and make recommendations for improvement.
  • Training and Development: Collaborate on the development of learning modules and support training in the care management process for team members, ensuring they have the necessary skills to provide high-quality care.
  • Process Improvement: Partner with the Care Management Leadership Team to identify areas for process improvement and implement changes to enhance the care management process.
  • Tracking and Reporting: Develop and maintain tracking systems to identify training needs and provide regular reports to the Care Management Leadership Team.
  • Collaboration and Communication: Collaborate with Care Team members to review and revise contributions to assessment information and Care Plan, ensuring that all team members are aligned and working towards the same goals.
  • Case Management: Manage a caseload of high-risk members while maintaining lead responsibilities, ensuring that all members receive high-quality care and support.
  • Quality Assurance: Sign off on LVN TOC & HRA assessments, ensuring that all assessments are completed accurately and in a timely manner.
Requirements:
  • Experience: A minimum of five (5) years of experience in a combination of Care Management experience in a healthcare delivery setting or in a Managed Care (HMO, IPA) or in acute facility (i.e., hospital) Care Management.
  • Clinical Licensure: Possession of one (1) of the following active, unrestricted, and unencumbered clinical licenses issued by the appropriate California state board: Registered Nurse (RN) license, Clinical Social Worker (LCSW) license, or Marriage and Family Therapist (LMFT) license.
  • Education: Associate degree in a related field from an accredited institution required. In lieu of the required degree, a minimum of two (2) years of additional relevant work experience is required.
Additional Requirements:
  • Knowledge: Knowledge of regulatory standards of all BHCM policies and procedures, including Medicare, CM, DHCS, DMHC, and NCQA.
  • Technical Skills: Knowledge in Microsoft Suite programs, including Excel, Word, and PowerPoint.
  • Communication Skills: Excellent written and verbal communication skills, with the ability to effectively communicate with team members, leadership, and members.
  • Analytical Skills: Strong analytical skills, with the ability to interpret and analyze data to inform care management decisions.
About Inland Empire Health Plan:

Inland Empire Health Plan is a leading health plan dedicated to providing high-quality care to our members. We are committed to creating a work environment that values diversity, equity, and inclusion, and we are seeking a talented and dedicated individual to join our team.

Work Model:

This position is on a hybrid work schedule, with a mix of remote and on-site work in Rancho Cucamonga, CA.

Pay Range:

USD $58.13/Hr.

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