The Supervisor will be responsible for the daily operation of case management activities, the implementation of new programs, and compliance with regulations. S/he will provide guidance to staff or directly handle complex case management referrals. The position serves as a resource for CalOptima providers, health networks and community partners. Oversee the process, management and tracking of case management referrals. Monitor, train, and manage team of case managers and non-licensed staff. Provide guidance to staff or directly manage complicated case management requests from members, providers or staff. Assist with the development and oversight of case management programs, work plans and reports. Review and revise policies and procedures to ensure NCQA, CMS and DHCS regulatory compliance. Review health network complex case management files on a monthly basis to ensure compliance with accreditation and regulatory guidelines. Participate in health network oversight activities, as required. Assist with assessment activities and other process improvement strategies to enhance the effectiveness of the case management department. Maintain knowledge of current regulatory requirements and industry trends. Act as a resource for CalOptima providers, health networks and community partners. Participate in internal and external committees, coalitions and events such as health fairs, as appropriate.
Bachelor’s degree in Social Work or Nursing or equivalent work experience is required. If candidate is a nurse, current, unrestricted RN license to practice in the State of California is required. 5+ years of case management experience, preferably in a managed care setting and with Medicare and Medicaid/Medi-Cal populations required. Active Certified Case Manager (CCM) certification preferred. Previous supervisory experience preferred. Utilize disease process and clinical practice guidelines. Appropriate techniques, practices and cultural sensitivities to serve social and ethnic groups. Think critically to solve problems effectively. Effectively utilize computer and appropriate software and interact as needed with CalOptima Information Services.
Application Process: For a complete job description and to apply online, please go to www.caloptima.org. Questions can be directed to Debbie Neal, Senior Recruiter, 657-235-6891 or email@example.com.
Internal Number: 16044
CalOptima is a county organized health system that administers publicly funded health care coverage for low-income children, adults, seniors and people with disabilities in Orange County, California. CalOptima’s mission is to provide members with access to quality health care services delivered in a cost-effective and compassionate manner. With $3.4 billion in annual revenue, CalOptima serves nearly 800,000 members, delivering services through 14 health networks. For the past three years, CalOptima has been rated the top quality Medi-Cal plan in California, according to the National Committee for Quality Assurance (NCQA) Medicaid Health Insurance Plan Ratings 2017–2018.