Partnership HealthPlan of California

Manager of Clinical Integration

Job Locations US-CA-Fairfield | US-CA-Santa Rosa | US-CA-Redding | US-CA-Eureka | US-CA-Chico | US-CA-Auburn
Job ID
2024-3305
FLSA Status
Exempt
Hiring Range
$136,296.78 - $177,185.82

Overview

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

Responsibilities

  • Provides day-to-day direction to Care Coordination’s Clinical Integration Team’s
    Supervisors, and Individual Contributors to meet department goals and objectives and to
    ensure compliance with company policies.
  • Directly conducts team performance management, including onboarding activities and
    annual performance evaluation process. Keeps Associate Director apprised of staff
    concerns 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 and
    Communications, and other Partnership departments to identify, track, and monitor
    alignment for Care Coordination activities across the organization
  • In relation to Care Coordination programs, works with other departments within
    Partnership to develop and implement improvements that will lead to improved
    performance or enhanced workflow of staff.
  • Monitors and provides data for reporting that will support the efficacy of each CC
    activity/program and to produce dashboards that includes a summary of CC program
    activities, member outcomes, return on investment, and quality improvement activities,
    including formal regulatory submissions. .
  • Assists in developing structures, relationships, and processes to promote active
    partnerships with providers, community stakeholders, and/or other healthcare
    professionals to meet and support key organizational initiatives (ex: MOU requirements,
    CalAIM, etc.)
  • Assists with audit and survey readiness activities to ensure the department is compliant
    with all applicable regulation and DHCS standards, licensure requirements, accreditation
    standards (i.e. NCQA), new legislation, and Partnership policies and procedures throughthe guidance of deliverables provided by direct reports across training, program
    development, 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 appropriate
    and 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. Develops
    annual goals for individual performance and updates at least every six (6) months for
    progress.
  • 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 work
    activities, implementing workplace changes, conducting annual reviews, and conducting
    staff trainings.
  • Works with operational Managers and Supervisors, and the training team to develop
    standardized training content and material for new staff and for the ongoing education of
    existing 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 medical
management setting, with effective problem solving in an area where few
precedents have been set; or equivalent combination of education and
experience. Program or product development experience strongly
preferred.

 

Special Skills, Licenses and Certifications

Effective telephone and computer skills required. General knowledge of
utilization management, ICDCM, and CPT coding schemes. Thorough
knowledge of case management programs and application of related
clinical criteria and protocols. Knowledge of and experience with
Federal Medicaid and/or California Medi-Cal programs and Medicare
experience in managed care settings preferred. Ability to work
effectively across departments and functions within the organization.
Proficiency with PCs and medical management software, word
processing, spreadsheets, etc. Valid California driver’s license and proof
of current automobile insurance compliant with Partnership policy are
required to operate a vehicle and travel for company business.

 

Performance Based Competencies

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

 

Work Environment And Physical Demands

Ability to use a computer keyboard. Ability to prioritize workload and
initiate action to acquire needed information from professionals by
phone. Ability to function effectively with frequent interruptions and
direction from multiple team members. More than 50% of work time is
spent in front of a computer monitor. Must be able to lift, move, or carry
objects 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.

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