RN Job
Manager, Care Management
Full-time
Req #7537
Los Angeles, 90017
Responsibility includes regulatory compliance, accreditation compliance, oversight of Plan Partners' and Delegated Provider Groups related operations, oversight of care management related delegated functions, operations for direct lines of business and/or management services agreement functions, and interfacing with external agencies including other Local Initiatives, Plan Partners and external organizations.
Oversees and monitors operational compliance with organizational standards, policies and procedures and regulatory requirements. Assures department meets all regulatory time frames on CM. Develops and implements departmental policies and procedures. Develops and maintains departmental statistical and performance reports. Develops, implements and monitors performance standards. Develops and maintains effective communication mechanisms at various levels of the organization and with external organizations.
Qualifications
- Master's Degree in Social Work
- .Education Preferred Associate's Degree
- Bachelor's Degree in Nursing
- At least 4 years of recent care management experience in a hospital or managed care setting, such as a health insurance environment and/or experience as care manager in home health or hospice environments.
- At least 3-5 years of management/supervisory experience and relevant health plan experience.
- Experience with Medi-Cal and Medicare populations and regulatory requirements.
- Active & Current Driver's License, with a clean record and Auto Insurance Required
- Licensed Clinical Social Worker (LCSW) - Active, current and unrestricted California License
- Licenses/Certifications Preferred
- Registered Nurse (RN) - Active, current and unrestricted California LicenseCertified Case Manager (CCM)
About the Hospital
As the nation's largest publicly-operated health plan, we have a great responsibility to the communities we serve, and our employees play an essential role in ensuring we meet those needs.
Why Join Us?
Opportunity. Amazing co-workers. A supportive management team. Great compensation and benefits. Camaraderie and a true sense of mission. If you want a career that truly contributes to the good of all, join us as we work towards a healthier L.A.
