Sr. Manager, Case Management (Population Health) Position Available In Plymouth, Massachusetts

Job Description:

Your Role The Care management team is looking for a leader withMedi-Cal experience who can help design and lead our Medi-Cal lineof business. The Senior Manager of Care Management, Medi-Cal willreport to the Director of Care Management in the Population HealthDepartment In this role you will be will serve as the professionalleader of registered nurses within Blue Shield care management whois a good collaborator, experienced in people leadership, and willserve as a mentor and advisor to senior leadership. The selectedcandidate will also function as the subject matter expert onprofessional nursing/ care management for Medi-Cal regulations- whowill represent care management in initiatives, clientpresentations, act as a liaison between other business units withinBlue Shield to bolster care management knowledge on communityresources, best practices, and promote holistic and integratedapproach to medical care management. . Our leadership model isabout developing great leaders at all levels and creatingopportunities for our people to grow – personally, professionally,and financially. We are looking for leaders that are energized bycreative and critical thinking, building and sustaininghigh-performing teams, getting results the right way, and fosteringcontinuous learning. Your Work Your Work In this role, you will:

Establish operational objectives for department or functional areaand participates and leads other managers to establish groupobjectives Be responsible for team, department or functional arearesults in terms of planning, cost and methods in collaborationwith Director Participate in the development and implementation ofthe annual budget under the direction of Director Ensure workflowprocedures and guidelines are clearly documented and communicatedInterpret or initiate changes in guidelines/policies/proceduresProvides leadership to ensure best utilization of resources inobtaining organizational goals, regulatory compliance, adhering tocorporate policies through oversight of daily operations,assessment of adequacy of staffing, and adherence to standard ofsocial workers Enhancement or creation of care management processesin compliance with regulatory requirements Maintenance andoperationalizing of the Model of Care (MOC) for Medi-Cal SPDmembers, Cal-AIM, and other contracts with DHCS and CMS in closecollaboration with and guidance from Director of Care ManagementResponsible for ensuring that the care management departmentreadiness for internal and external regulatory and accreditationaudits Primary involvement with committees, projects, initiatives,professional associations, and other service providers to promoteappropriate and cost-effective care delivery for the populationFocused on services and programs to increase quality of life andhealth of all members Macro level collaboration and involvementwith committees, projects, initiatives, community leaders, countysocial service personnel, professional associations, and otherservice providers to promote appropriate and cost-effective caredelivery for the population Demonstrates a passion for leadingpositive change by enhancement and sustainment of an innovativecare management program that advocates for patient safety bykeeping informed of mandates, regulations, and best practiceinnovations Enhancement and development of client health education,Advance Healthcare Planning and End of Life counseling and supportand promotes participation in staff, patient, and communityeducation Promotion of best practice in impacting socialdeterminants of health and homelessness Represent Blue Shield caremanagement in Blue Shield sponsored community events and fairsRegular collaboration with other Blue Shield managers in caremanagement and other business units Maintain daily measurementstandards and outcomes for staff An active participant in practicetransformation Your Knowledge and Experience Requires a bachelor’sdegree or equivalent experience Requires a current CA RN LicenseCertified Case Manager (CCM) Certification or is in process ofcompleting certification when eligible based on CCM applicationrequirements Requires at least 10 years of prior relevantexperience including 4 years of management experience gained as ateam leader, supervisor, or project/program manager Requires healthinsurance/managed care experience (Commercial, Medicare, andMedi-Cal). Requires excellent communication, presentation, andprocedure-writing skills Lean methodology desired Advanced degreepreferred