Clinical Care Manager
- Must be able to commute to our office in South San Francisco two times per week
- Opportunity to make a difference in your community
- Position not eligible for sponsorship
General Description
The Clinical Care Manager will perform comprehensive assessments, develop individualized care planning, initiate, and coordinate interdisciplinary case conferences with providers of service, support members in creating and adhering to person-centered care plans. Additionally, the Clinical Case Manager will be coordinating services with other departments, providers, programs, and community partners, as needed, to provide support.
Duties & Responsibilities
Essential Functions:
- Manage a panel of assigned members to guide along the continuum of care to the optimal functional level and quality of life.
- Conduct comprehensive assessments and annual or as needed reassessments of the member’s psychosocial, physical health, functional abilities, and social determinants of health.
- Develop an individualized care plan based on assessment information that is member-centered, comprehensive, and consistent with program guidelines and policies and procedures.
- Identifies member’s need for LTSS programs, Behavioral Health Services, community supports and other services to fill gaps in care, monitors effectiveness of services.
- Conducts outreach to members for care plan review, needs assessment and acuity monitoring.
- Establishes and maintains open and effective communication with physicians and other health care and social service workers. Provides appropriate information on all significant aspects of member’s care and program operations, while maintaining necessary confidentiality.
- Maintains necessary and complete documentation for all case management activities in the plan’s case management system, MedHOK.
- Leads and/or participates in clinical huddles and interdisciplinary care team meetings with internal HPSM staff and external partners and providers.
- Make referrals to various HPSM departments, community-based organizations, and governmental agencies when health and/or psychosocial condition(s) indicate need for appropriate referrals(s).
- Promotes clear communication amongst the care team, which can include family and community support, and treating providers by ensuring awareness regarding member care plans, and when supporting care transitions.
- Teach appropriate interventions, link to resources, educate about benefits, and discuss medication effects and side effects to patients, caregivers, volunteers, and others as appropriate.
- Always adhere to case management practice standards.
- Participate in continuous quality improvement efforts.
- Maintain knowledge of HPSM benefits, programs, and processes, to provide clear information to members and providers.
- Maintain knowledge of community resources and programs.
- Maintain working knowledge of confidentiality practices and standards. Adheres to all standards of confidentiality and patient health information.
Secondary Functions: Perform other necessary duties as assigned.
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 experience:
- Bachelor or Associates degree.
- Two (2) years clinical experience.
- Three (3) years of managed care experience, preferably in Care Coordination.
- Experience working with the health needs of the population served.
- At least one year of direct Care Coordination experience.
- Valid California license as a RN, LCSW, LMFT. PHN preferred. Will consider unlicensed Masters Level Social Worker (MSW/ASW).
- Certification as Certified Case Manager (CCM) preferred.
Knowledge:
- Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, and PowerPoint.
- Case management principles and practices.
- Strong knowledge of Medicare and Medi-Cal programs and benefits.
- Advanced knowledge of community resources.
- Complexities of working with the elderly, vulnerable and disabled populations.
- Expanded knowledge of social determinants of health.
- Understanding and familiarity of care transitions and discharge planning.
- HIPAA and other applicable federal and state regulations for confidentiality.
Skills:
- Demonstrate member, provider and interdisciplinary team focused interpersonal skills.
- Work effectively with people in varying positions and diverse backgrounds, by maintaining cultural competency, knowledge, and practice.
- Communicate effectively through written, verbal and listening communication skills.
- Conflict resolution, assertiveness, and collaboration skills
- Bilingual skills highly preferred, particularly Spanish, Tagalog, or Chinese.
Abilities:
- Adapt to changes in requirements/priorities for daily and specialized tasks.
- Work autonomously and be directly accountable for practice of case management.
- Work collaboratively with others.
- Work as part of a team and support team decisions.
- Utilize member-centric approach to care coordination.
- Function effectively in a fluid, dynamic, and rapidly changing environment.
- Influence and gain consensus on individual and group decision-making.
Salary and benefits
The starting salary range is $89,554 - $118,659 per year, depending on the candidate’s work experience.
Excellent benefits package includes:
- HPSM-paid premiums for employee’s medical, dental and vision coverage (employee pays 10% of each dependent’s premiums)
- Fully paid life, AD&D and LTD insurance
- Retirement plan (HPSM contributes equivalent of 10% of annual compensation)
- 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year
- Tuition reimbursement plan
- Employee wellness program
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.
Job Type: Full-time
Pay: $89,554.00 - $118,659.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible schedule
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Parental leave
- Professional development assistance
- Referral program
- Retirement plan
- Tuition reimbursement
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Application Question(s):
- Ability to work Monday - Friday (8am-5pm)
- Ability to work in-person as needed or required
Experience:
- Managed Care Plan: 1 year (Required)
License/Certification:
- RN License (Preferred)
- Licensed Certified Social Worker (Preferred)
Work Location: Hybrid remote in South San Francisco, CA 94080