Manager Integrated Care

Company: IEHP
Location: Rancho Cucamonga
Posted on: March 16, 2023

Job Description:

Position Summary/Position Under the direction of the Director of Integrated Care, assist in the oversight of the regional/integrated CM/BH & Quality Teams to ensure compliance with regulatory guidelines (DHCS, NCQA, DMHC). Support the implementation of new policies and procedures that will allow the regional teams to identify and enroll members needing case management. Work collaboratively with the Director of Integrated Care to develop integrated workflows that better address the holistic needs of our members across the continuum of care. Oversee the operational aspects of the BHCM Call Center, coordinating daily staffing to ensure the delivery of high-quality services to Members and ensuring services are in compliance with regulatory requirements. Major Functions (Duties and Responsibilities) 1. Work collaboratively with the Director of Integrated Care to design and implement processes that allow for IEHP to identify Members that could benefit from a care management program. 2. Assist in the development of processes within the care teams to identify and address members holistic needs. 3. Assist the Director of Integrated Care in implementing a high-risk/high-touch outward-facing CM program to address complex populations. 4. Assist in the ongoing monitoring of the quality oversight program within CM. 5. Work collaboratively with other departments to streamline referrals to CM. 6. Assist in preparing the integrated/regional care team to address subpopulations as requested by regulators (DHCS/NCQA). 7. Responsible for the management of call center operations, ensuring accurate completion of the authorization data entry tasks, continuity of care, BH authorization processes and supervision of BH Specialists. 8. Monitor and provide direction to the BH Specialists and Coordinators to ensure implementation of timely processes, follow-through of calls, and task completion, providing support to Team Members when questions arise concerning covered services and contracted Providers. 9. Monitor metrics for the CM/BH Department, which will assist in evaluating the overall state of the department. Major Functions (Duties and Responsibilities) Cont Supervisory Responsibilities Leader: Administers Hires, Terminations, and Performance Reviews Experience Qualifications A minimum of three (3) years of experience in a health care setting. A minimum of three (3) years of experience in a managed care setting and three (3) years in leadership. Preferred Experience Education Qualifications Masters degree from an accredited institution required, degree preferably in a Health-Care related field or Business Administration accredited institution. Preferred Education Professional Certification Professional Licenses Drivers License Required Yes, must have a valid California Driver's License. Knowledge Requirement Knowledge of health plan regulations (DHCS, CMS, DMHC and NCQA & LTSS). Well informed of the resources available in the Inland Empire to support Members (community resources, BH programs, waiver, and grant programs). Knowledge of the CM/BH Programs. Knowledge of Lean principles to problem solve and evaluate program effectiveness. Skills Requirement Excellent verbal and written communication skills. Ability to use Microsoft products excel, access, power point and word. Public Speaking. Policy review and editing. Excellent interpersonal skills. Abilities Requirement To develop and implement programs using Lean tools. Ability to organize and follow through. Must be able to meet deadlines. To be a servant leader to the Director of Integrated Care and the integrated care team. Commitment to Team Culture The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization. Working Conditions Position may require travel and participation to external work groups/meetings. Work Model Location Hybrid Physical Requirements Keyboarding: Traditional - FREQUENTLY Keyboarding: Touch-Screen - FREQUENTLY Keyboarding: 10-Key - FREQUENTLY Hearing: One-on-One - FREQUENTLY Communicate: Information/ideas verbally - FREQUENTLY Near Visual Acuity - FREQUENTLY Regular contacts: co-workers, supervisor - FREQUENTLY Sitting - CONSTANTLY Lighting - FREQUENTLY Indoors - FREQUENTLY Memory - FREQUENTLY Understand and follow direction - FREQUENTLY Regular and reliable attendance - CONSTANTLY A reasonable salary expectation is between $118,248.00 and $150,779.20, based upon experience and internal equity. Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as Great Place to Work. With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace. As the healthcare landscape is transformed, were ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan. Nearest Major Market: Riverside Nearest Secondary Market: Los Angeles Apply now

Keywords: IEHP, Rancho Cucamonga , Manager Integrated Care, Executive , Rancho Cucamonga, California