What are the responsibilities and job description for the Senior Clinical Care Manager position at Health Plan of San Mateo?
Make a difference in the lives of others! Join HPSM as a Senior Care Manager and play a vital role in improving healthcare outcomes for members with complex medical and psychosocial needs. You'll work closely with members and their care teams to develop individualized care plans, coordinate services, and ensure the delivery of high-quality, efficient care. This role also serves as a clinical subject matter expert, providing guidance on complex cases and supporting program development within the Integrated Care Management (ICM) model.
Key Responsibilities
- Manage a panel of assigned members, conducting comprehensive assessments to identify physical, psychosocial, environmental, and safety needs.
- Develop and implement member-centered care plans in collaboration with the member, their family, primary care provider, and care team.
- Apply evidence-based clinical guidelines and risk stratification to guide case management interventions.
- Provide ongoing support by coordinating with internal HPSM teams (e.g., inpatient / outpatient UM, pharmacy) to ensure effective service delivery.
- Identify and support members with complex medical and behavioral health needs, ensuring appropriate assessments, screenings, and care planning.
- Facilitate interdisciplinary team (IDT) meetings, clinical huddles, and community partnerships to enhance care coordination and avoid service duplication.
- Maintain timely and accurate documentation in the electronic medical record (EMR) within 48 hours of contact.
- Offer cross-coverage support to other care management teams and provide consultation on complex cases.
- Make referrals to internal departments, community-based organizations, and government agencies as needed.
- Educate members, caregivers, and providers on healthcare benefits, medications, and available resources.
- Support quality improvement initiatives, audits, NCQA accreditation, and compliance activities.
- Contribute to program development and process improvements within the ICM model.
Requirements
These are the qualifications typically needed to succeed in this position. However, you don't need to meet every requirement to apply.
Education and Licensure
Experience
Skills and Abilities
Benefits
Excellent benefits package includes :
It is HPSM's policy to provide equal employment opportunity for all applicants and employees. HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law. HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics.
Other details
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Salary : $49 - $63
