Medicare Care Management Manager (RN)

Location: Mariposa County, California; Merced County, California; Monterey County, California; San Benito County, California; Santa Cruz County, California

We have an opportunity to join the Alliance as the Medicare Care Management Manager (RN) in the Care Management Department.

Reporting to the Care Management Director, this position:

• Plans, organizes, manages, and leads the Care Management Medicare team, acts as a subject matter expert, and provides guidance related to care management activities
• Provides management oversight related to the Care Management Medicare Unit functions and departmental operations
• Performs program effectiveness evaluation
• Manages, supervises, mentors, and trains assigned staff
• Collaborates with a variety of Alliance staff on special projects

ABOUT THE TEAM

Our mission is to coordinate care and empower members to achieve their health and wellness goals through collaboration and by facilitating member relationships with community providers.

We bring the voice of the member into the room when collaborating with our fellow departments at the Alliance.

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here.

• Knowledge of:
  
  
  
  • The principles and practices of clinical nursing
  • The principles and practices of case management
  • The principles and practices of supervision and training
  • Care management and coordination
  • Medi-Cal and related policy and benefits-related Title 22 regulations
  • Medicare D-SNP and related regulations
  • Concepts and guidelines related to managed care and prepaid healthcare
  
  
  
  
• Ability to:
  
  
  
  • Analyze and interpret legal, regulatory, and contractual language, policies, procedures and guidelines, and legislative and regulatory directives
  • Train, mentor, supervise, and evaluate the work of staff, promote an atmosphere of teamwork and cooperation, and motivate staff to achieve goals and objectives
  • Act as a technical resource and explain regulations, processes, and programs related to area of assignment
  • Organize and prioritize the work of others, delegate effectively, and follow up on work assignments
  • Provide leadership and facilitate meetings
  • Plan, organize, and lead data collection activities
  • Present statistical and technical care management data in a clear and understandable manner utilizing appropriate visual aids
  
  
  
  
• Education and Experience:
  
  
  
  
  • Current and unrestricted license as a Registered Nurse issued by the state of California
  • Bachelor's degree in Nursing
  • Six years of experience in a health plan or patient care setting, which included a minimum of two years of experience supervising and training a multi-disciplinary health care team, one year of case management experience, and some experience in a care management capacity (a Master's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying Experience; or an equivalent combination of education and experience which would provide the required knowledge, skills and abilities may be qualifying
  
  
  
  

OTHER INFORMATION

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below.

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area

Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area