San Francisco Health Plan
Manager, D-SNP Care Management
San Francisco Health Plan, San Francisco, California, United States, 94199
Reporting to the Director, Care Management, the Manager, D-SNP Care Management is responsible for the operation of the D-SNP Care Management team, large-scale care management initiatives, managing staff, and oversight of functions. You will lead the development of department policies and processes, ensuring that all workflows are documented with a focus on quality improvement. You will oversee regulatory audits and respond to inquiries related to departmental services. You will build a high-performing team of Clinical Supervisors, Nurses Care Managers, and Coordinators committed to providing exemplary service and ensuring the delivery of high-quality care to our members.Salary:
$140,000 to 154,000 annualWHAT YOU WILL DO:Oversight and performance of the D-SNP Care Management team, including the daily activities within CM areas that serve dual eligible members.Provide direct oversight and guidance to the Clinical Supervisors and other staff, thereby creating a high-performing team through coaching individuals to set and exceed personal and department goals.Provide opportunities for staff in self-learning and skill development and promoting a healthy team atmosphere.Model for staff “data-driven quality improvement” as it applies to the D-SNP Care Management programs and large-scale initiatives.Ensure Clinical Supervisors create and maintain a training plan to train and orient all staff.Understand and enforce all applicable regulatory and quality requirements for the dual eligible membership (DHCS, CMS, NCQA, and others), which include care management, utilization management, and grievance and appeals.Responsible for development and updates to policy and procedures, workflows, and department documents.Participate in special projects pertaining to Care Management.Develop and improve Care Management program metrics, at the organizational level and at the individual staff level.Prepare reports on Care Management activities according to established schedules and format. Identify patterns and trends and, in collaboration with the Director, develop and implement corrective action plans.Develop strong partnerships with peer functional leaders from other teams to help maximize company resources and deliver positive outcomes.Responsible for department budgetary resources, including bonus allocation in a pay-for-performance plan.Collaborate with the Health Services Product Management (HSPM) and Business Analytics (BA) teams to update and monitor the CM dashboards on a monthly basis while analyzing and reporting overall trends to the Director.Provide clinical leadership and expertise when needed across the Health Services department and health plan as a whole.Ensure the privacy and security of PHI (Protected Health Information) as outlined in SFHP's policies and procedures relating to HIPAA compliance.Monitor workload and potential staffing needs and changes due to changes in workload, including making recommendations for budgetary purposes. Develop and implement a staff hiring and retention strategy in collaboration with the Clinical Supervisors.Oversee inter-rater reliability reviews and implement changes.Ensure that our care management system, JIVA, is being optimized to support new and evolving programs.WHAT YOU WILL BRING:A current State of California RN license to practice without restriction; bachelor’s degree in nursing required.3+ years of experience within a managed care setting.3 years of demonstrated leadership experience in a supervisory or team lead role.Experience with D-SNP Care Management program development and evaluation.WHAT WE OFFER:Medical: You’ll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.Dental: You’ll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.Vision: Employee vision care coverage is available through Vision Service Plan (VSP).Retirement – Employer-matched CalPERS Pension and 401(a) plans, 457 Plan.Time off – 23 days of Paid Time Off (PTO) and 13 paid holidays.Professional development: Opportunities for tuition reimbursement, professional license/membership.ABOUT US:Established in 1997, San Francisco Health Plan (SFHP) is an award-winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco County. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services.San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.San Francisco Health Plan is an E-Verify participating employer.Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.
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$140,000 to 154,000 annualWHAT YOU WILL DO:Oversight and performance of the D-SNP Care Management team, including the daily activities within CM areas that serve dual eligible members.Provide direct oversight and guidance to the Clinical Supervisors and other staff, thereby creating a high-performing team through coaching individuals to set and exceed personal and department goals.Provide opportunities for staff in self-learning and skill development and promoting a healthy team atmosphere.Model for staff “data-driven quality improvement” as it applies to the D-SNP Care Management programs and large-scale initiatives.Ensure Clinical Supervisors create and maintain a training plan to train and orient all staff.Understand and enforce all applicable regulatory and quality requirements for the dual eligible membership (DHCS, CMS, NCQA, and others), which include care management, utilization management, and grievance and appeals.Responsible for development and updates to policy and procedures, workflows, and department documents.Participate in special projects pertaining to Care Management.Develop and improve Care Management program metrics, at the organizational level and at the individual staff level.Prepare reports on Care Management activities according to established schedules and format. Identify patterns and trends and, in collaboration with the Director, develop and implement corrective action plans.Develop strong partnerships with peer functional leaders from other teams to help maximize company resources and deliver positive outcomes.Responsible for department budgetary resources, including bonus allocation in a pay-for-performance plan.Collaborate with the Health Services Product Management (HSPM) and Business Analytics (BA) teams to update and monitor the CM dashboards on a monthly basis while analyzing and reporting overall trends to the Director.Provide clinical leadership and expertise when needed across the Health Services department and health plan as a whole.Ensure the privacy and security of PHI (Protected Health Information) as outlined in SFHP's policies and procedures relating to HIPAA compliance.Monitor workload and potential staffing needs and changes due to changes in workload, including making recommendations for budgetary purposes. Develop and implement a staff hiring and retention strategy in collaboration with the Clinical Supervisors.Oversee inter-rater reliability reviews and implement changes.Ensure that our care management system, JIVA, is being optimized to support new and evolving programs.WHAT YOU WILL BRING:A current State of California RN license to practice without restriction; bachelor’s degree in nursing required.3+ years of experience within a managed care setting.3 years of demonstrated leadership experience in a supervisory or team lead role.Experience with D-SNP Care Management program development and evaluation.WHAT WE OFFER:Medical: You’ll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.Dental: You’ll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.Vision: Employee vision care coverage is available through Vision Service Plan (VSP).Retirement – Employer-matched CalPERS Pension and 401(a) plans, 457 Plan.Time off – 23 days of Paid Time Off (PTO) and 13 paid holidays.Professional development: Opportunities for tuition reimbursement, professional license/membership.ABOUT US:Established in 1997, San Francisco Health Plan (SFHP) is an award-winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco County. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services.San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.San Francisco Health Plan is an E-Verify participating employer.Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.
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