Clinical Program Manager – Managed Care Full Time

DUTIES

Summary

Manages the planning, organization, and implementation of Managed Care Provider (MCP) benefits including but not limited to Enhanced Care Management (ECM), Community Supports (CS) and Community Health Worker (CHW).

Essential Duties

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Manages assigned programs to ensure compliance with all agency policies and procedures including adhering to all MCP, local, state and/or federal funding requirements.
• Manages all aspects of related projects including their implementation, space planning, staff recruitment, service development, community outreach and marketing.
• Maintains ongoing communication and certification procedures with managed care providers and other contractual partners.
• Schedules and participates in regular meetings with managed care providers.
• Seeks opportunities to build relationships with health care providers, local and community organizations, government agencies to support enrolled members and staff.
• Coordinates ongoing communication with other agency programs and community partners to support internal referrals into MCP benefits.
• Ensures all staff are provided with individualized orientation plans, training plans, direct field observations and performance evaluations.
• Leads case conferences and team meetings to monitor individual needs and services plan to ensure effective quality clinical service delivery in alignment with CII’s service philosophy.
• Ensures that member insurance eligibility and accuracy of the Targeted Engagement List/Member File, and timely tracking of outreach activities is confirmed monthly.
• Ensures timely, high-quality documentation of services in accordance with CII and contractual requirements including ensuring charts are audit ready at all times.
• Utilizes the data (program outcomes, enrollment numbers, conversion rates, etc.) to improve program procedures, identify needs, and highlight program successes.
• Collaborates with other CII departments to ensure program requirements are met.
• Partners with management team to integrate cross program activities and function.

Additional Duties

• Other duties and special projects as assigned.

SUPERVISORY RESPONSBILITIES

• Responsible for the overall direction, coordination, and evaluation of the direct reports.
• Carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
• Position supervises 4-6 staff.

Qualifications

EDUCATION & EXPERIENCE

• BA/BS Degree in Health Administration, Nursing, Public Health, Social Work, Psychology or related field required; Master’s degree in Health Administration, Nursing, Public Health, Social Work, Psychology or related field preferred (substitutes for two years of supervisory experience).
• 3+ years of managerial, supervisory experience.
• 5 years of professional level outpatient medical, community health service delivery, behavioral practice management, or related healthcare experience.

Other Qualifications

• Valid driver’s license and state-required auto insurance.
• May require some travel.
• Ability to work with minimal supervision.
• Spanish / English bilingual preferred.
• Ability to handle confidential information.
• Maintains patient privacy, including protecting the confidentiality, safeguarding the integrity and availability, and limiting the use and disclosure of patient Protected Health Information (PHI) to authorized individuals and entities.
• Participates in, conducts, and sustains performance quality improvement activities according to designated role and responsibilities.
• Sensitivity to service population’s cultural and socioeconomic characteristics.
• Excellent verbal and written communication skills.

CERTIFICATES, LICENSES, REGISTRATIONS

• Board of Behavior Sciences (BBS) or Board of Psychology (BOP) license preferred.

Computer Skills

• Advanced knowledge Microsoft Office 365 (Word, Excel, Teams, etc.)

Vision Requirements

• No special vision requirements.

NOISE LEVEL

• Moderate noise

Required Training

• New Hire Orientation
• AB1825: Harassment Prevention training
• Mandated Reporter
• CPR/First Aid

Compensation

$104,616.00 USD – $130,770.00 USD

In accordance with California law, the expected pay range for this position is included in this posting. The actual compensation will be determined based on factors permitted by law. New hires will be offered a salary at the starting point of the range to maintain internal inequity and allow opportunity for future salary growth. CII salaries are determined based on comprehensive internal and external market analysis, as well as the skills, education, and experience relevant to each position.

Benefits

• Generous paid PTO, plus 10 paid holidays and CII is closed between Christmas and New Year
• Excellent medical, dental, and vision insurance for eligible employees and qualified dependents
• 403b Retirement Plan with employer contribution for eligible employees
• Up to $4,500 in tuition reimbursement per calendar year
• Eligible for the Public Service Loan Forgiveness program
• Flexible Spending Account (FSA) & Health Savings Account (HSA)
• Employer paid Life and AD&D Insurance
• Voluntary Supplemental Insurance
• Opportunity for growth & advancement
• Professional development & continued training
• Team building & bonding through company sponsored events & activities

Contingencies

• Influenza immunization or declination
• COVID-19, MMR and Tdap immunizations
• Education verification
• Reference check
• Background fingerprint clearance (FBI, DOJ, CACI) conducted by the California Department of Social Services
• Drug and alcohol screening
• Tuberculosis screening