Senior Care Manager

General Description HPSM seeks a dedicated Senior Care Manager to collaborate with members and their care teams in assessing, developing, and managing personalized care plans that drive optimal health outcomes for individuals with complex medical and psychosocial needs. This role integrates evidence-based clinical guidelines to enhance the quality and efficiency of care delivery for health plan members. As a clinical subject matter expert, the Senior Care Manager will provide consultation and support to fellow care managers on complex cases while also contributing to the development and advancement of the Integrated Care Management (ICM) model. Qualifications   The following represents the typical way to achieve the necessary skills, knowledge and ability to qualify for this position: Education and Experience Bachelor’s degree in nursing or master’s degree in social work. Three (3) years clinical case management experience in a medical or behavioral health field. Skills Bilingual skills (Spanish, Tagalog or Chinese) highly preferred. Communicate effectively, both verbally and in writing. Work cooperatively with others. Provide excellent customer service. Knowledge Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint. Case management principles and practices. Medicare and Medi-Cal programs and benefits. Community resources. The complexities of working with dually eligible populations. Abilities Work as part of a team and support team decisions. Adapt to changes in requirements/priorities for daily and specialized tasks. Work efficiently with people in varying positions. Gain consensus on resolution of problems. Work independently, with limited supervision; problem solve independently. The incumbent must have own vehicle and valid driver’s license with proof of insurance in conformity with state law minimums. Licensure/Certifications Valid California license as a Registered Nurse (RN), or Licensed Clinical Social Worker (LCSW) is required. Certification as Certified Case Manager (CCM) or other clinical certifications preferred. Driving The incumbent must have own vehicle and valid driver’s license with proof of insurance in conformity with state law minimums. Duties & Responsibilities Essential Functions Role 1: Care Coordination and Case Management Manage a panel of assigned members, conducting comprehensive assessments to identify physical, psychosocial, environmental, safety, and developmental needs. Develop and implement individualized care plans in collaboration with members, their authorized representatives, primary care providers, and other care team members. Utilize risk stratification and evidence-based clinical guidelines to implement case management interventions that optimize health outcomes. Coordinate care with community resources and interdisciplinary teams to prevent service duplication and ensure seamless care transitions. Facilitate referrals to HPSM departments, community-based organizations, and government agencies as needed. Role 2: Member Support and Advocacy Provide ongoing support to members throughout their healthcare journey by collaborating with internal departments such as Inpatient and Outpatient Utilization Management (UM) and Pharmacy. Identify members with complex medical and behavioral health needs, ensuring the completion of assessments and development of member-centric care plans. Engage in interdisciplinary team (IDT) meetings and clinical huddles to monitor service delivery and ensure alignment with member needs. Educate members, caregivers, and other stakeholders on interventions, resources, benefits, and medication effects to enhance self-management. Promote clear communication among care teams and treating providers by ensuring alignment on care plans and service coordination. Role 3: Compliance and Documentation Document all member interactions, provider communications, and IDT meetings in the electronic medical record (EMR) within 48 hours. Assist with internal and external audits, National Committee for Quality Assurance (NCQA) requirements, and other compliance-related tasks. Ensure adherence to regulatory and organizational policies while supporting department-wide process improvements and program expansion initiatives. Monitor and maintain high-quality care management practices through continuous quality improvement efforts. Role 4: Departmental Support and Collaboration Provide coverage for staff during planned and unplanned absences and offer cross-coverage across other care management tiers. Support departmental operations, including participation in special projects and assignments. Assist leadership with process improvement initiatives to enhance program efficiency and effectiveness. Act as a clinical subject matter expert and provide consultation on complex cases to other care managers. Secondary Functions Maintain a valid California license as a Registered Nurse (RN), or Licensed Clinical Social Worker (LCSW). Must maintain own vehicle and valid driver’s license with proof of insurance in conformity with state law minimums. Adhere to work performance norms and attendance expectations. Perform other duties as assigned.

Salary : $49 - $58