WHY CALOPTIMA?
CalOptima is the single largest health plan in Orange County, serving 880,000 members, or one in four residents. Our motto — "Better. Together.” — is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community’s health. If you’re looking for an opportunity to work for an organization dedicated to improving local health care and serving the needs of the most vulnerable, we encourage you to join CalOptima.
JOB SUMMARY
The Supervisor, Case Management is responsible for the daily operation of case management activities, the implementation of new programs, and compliance with regulations. The incumbent will provide guidance to staff or will directly handle complex case management referrals. The incumbent is accountable for establishing quality and productivity standards for the team and ensuring compliance with department policies and procedures in collaboration with the manager. The incumbent serves as a resource for CalOptima providers, health networks, and community partners.
POSITION RESPONSIBILITIES:
- Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
- Mentors, trains, and manages a team of case managers and non-licensed staff.
- Oversees the process, management, and tracking of case management referrals.
- Assists with the development and oversight of case management programs, work plans, and reports.
- Collaborates with other supervisors and managers in the department to improve processes and workflow.
- Assists in developing and revising policies and procedures to ensure National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid (CMS) and Department of Health Care Services (DHCS) regulatory compliance.
- Creates, documents, and updates desktop procedures.
- Participates in health network oversight activities.
- Assists with assessment activities and other process improvement strategies to enhance the effectiveness of the case management department.
- Maintains knowledge of current regulatory requirements and industry trends.
- Participates in internal and external committees, coalitions, and events such as health fairs, as appropriate.
- Attends meetings on behalf of the manager as needed.
- Completes other projects and duties as assigned.
POSSESSES THE ABILITY TO:
- Communicate clearly and concisely, both orally and in writing.
- Establish and maintain effective working relationships with CalOptima leadership and staff, providers, other program or agency representatives, and the public.
- Work as part of a team to manage or lead multiple projects simultaneously.
- Build team engagement.
- Systematically evaluate work and apply skills to continuously improve processes.
- Provide excellent customer service.
- Initiate and follow through on projects.
- Think critically to solve problems effectively.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
EXPERIENCE & EDUCATION:
- High School diploma or equivalent required.
- Current, unrestricted Registered Nurse (RN) license to practice in the State of California required.
- 3 years of experience in ambulatory case management required.
- 3 years of Managed Care experience, preferably with Medicare and Medicaid/Medi-Cal populations, required.
- An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.
PREFERRED QUALIFICATIONS:
- Bachelor’s degree in Nursing, Public Health, or another healthcare related field preferred.
- Active Certified Case Manager (CCM) certification preferred.
- Previous lead or supervisory experience preferred.
- Pediatric clinical or pediatric case management experience preferred.
KNOWLEDGE OF:
- Disease process and clinical practice guidelines.
- Case management, program planning, and evaluation.
- Appropriate techniques, practices, and cultural sensitivities to serve diverse communities.
DEPARTMENT(S): Case Management
REPORTS TO: Manager, Case Management
FLSA STATUS: Non-Exempt
SALARY GRADE: M - $40.87 - $63.99 ($85,000 - $133,100)
CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
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If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations by contacting Human Resources Disability Management at 657-900-1134.
Required Skills
Required Experience