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