Manager of Clinical Integration

Overview

Under direction of the Associate Director of Clinical Integration, leads and supports the clinicalintegration team in the enhancement and refinement of existing programs and the development,management, integration and refinement of new and existing programs. The Manager of ClinicalIntegration will ensure successful implementation of Care Coordination programs includingworking closely with Care Coordination’s operational leaders and internal and externalstakeholders to establish expected outcomes, plan roadmaps, and oversee alignment andexecution of deliverables. The Manager of Clinical Integration will directly oversee and supportthe clinical integration team consisting of supervisors and individual contributors across thetraining team, program and project roles, and the business and data analysts.

Responsibilities

• Provides day-to-day direction to Care Coordination’s Clinical Integration Team’sSupervisors, and Individual Contributors to meet department goals and objectives and toensure compliance with company policies.
• Directly conducts team performance management, including onboarding activities andannual performance evaluation process. Keeps Associate Director apprised of staffconcerns and accomplishments, and provides feedback on performance evaluations.
• Ensures activities related to programs are progressing with Health Equity, Quality,Member Services, and Population Health, along with Regional Leaders andCommunications, and other Partnership departments to identify, track, and monitoralignment for Care Coordination activities across the organization
• In relation to Care Coordination programs, works with other departments withinPartnership to develop and implement improvements that will lead to improvedperformance or enhanced workflow of staff.
• Monitors and provides data for reporting that will support the efficacy of each CCactivity/program and to produce dashboards that includes a summary of CC programactivities, member outcomes, return on investment, and quality improvement activities,including formal regulatory submissions. .
• Assists in developing structures, relationships, and processes to promote activepartnerships with providers, community stakeholders, and/or other healthcareprofessionals to meet and support key organizational initiatives (ex: MOU requirements,CalAIM, etc.)

• Assists with audit and survey readiness activities to ensure the department is compliantwith all applicable regulation and DHCS standards, licensure requirements, accreditationstandards (i.e. NCQA), new legislation, and Partnership policies and procedures throughthe guidance of deliverables provided by direct reports across training, programdevelopment, data and reporting

• Participates in onsite audits by various regulatory agencies as necessary.
• Provides oversight to department auditing to ensure compliance with DHCS
• Participates in the planning of new enhanced Health Services products.
• Assists in managing vendor relationships as assigned.
• Facilitates meaningful data presentations; uses data to identify needed process improvements.
• Actively participates in organizational meetings and goals; providing input where appropriateand informing assigned team of what is learned or changed as a result of those meetings.
• Participates in strategic goal setting for department activities and initiatives. Developsannual goals for individual performance and updates at least every six (6) months forprogress.
• Promotes the continuous improvement process and implements recommended changes.
• Provides daily leadership, direction, resources, training, evaluation and support to staff
• Performs Human Resources functions such as time card management, directing workactivities, implementing workplace changes, conducting annual reviews, and conductingstaff trainings.
• Works with operational Managers and Supervisors, and the training team to developstandardized training content and material for new staff and for the ongoing education ofexisting staff.
• Other duties as assigned

Qualifications

Education and Experience

Healthcare related degree or licensure strongly preferred. Minimum five(5) years of managed care experience (case management preferred;minimum five (5) years of management experience in a medicalmanagement setting, with effective problem solving in an area where fewprecedents have been set; or equivalent combination of education andexperience. Program or product development experience stronglypreferred.

Special Skills, Licenses and Certifications

Effective telephone and computer skills required. General knowledge ofutilization management, ICDCM, and CPT coding schemes. Thoroughknowledge of case management programs and application of relatedclinical criteria and protocols. Knowledge of and experience withFederal Medicaid and/or California Medi-Cal programs and Medicareexperience in managed care settings preferred. Ability to workeffectively across departments and functions within the organization.Proficiency with PCs and medical management software, wordprocessing, spreadsheets, etc. Valid California driver’s license and proofof current automobile insurance compliant with Partnership policy arerequired to operate a vehicle and travel for company business.

Performance Based Competencies

Demonstrated effective leadership and analytical skills. Effective oraland written communication skills. Excellent interpersonal skills

Work Environment And Physical Demands

Ability to use a computer keyboard. Ability to prioritize workload andinitiate action to acquire needed information from professionals byphone. Ability to function effectively with frequent interruptions anddirection from multiple team members. More than 50% of work time isspent in front of a computer monitor. Must be able to lift, move, or carryobjects of varying size, weighing up to 10 lbs.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures as they may from time to time be updated.

HIRING RANGE:

$136,296.78 - $177,185.82

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform.  The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Salary : $136,297 - $177,186