Description

　　PRINCIPAL RESPONSIBILITIES:

　　Under general direction of theDirector of Long-Term Supports and Services (LTSS), the Manager of Community Supports (CS) will be responsible for the oversight of Community Supports services with a focus on the members medical history and needs and the needs of the contracted Community Supports providers. This position will oversee members needs by providing the consultation, coaching and technical assistance to the CS providers regarding best practices and mandated services, including developing and maintaining an Alameda Alliance for Health program. This position will oversee the auditing and oversight of the CS providers, evaluating the necessary medical and community outreach resources to promote cost effective care with quality outcomes. The Manager of Community Supports will also be responsible for the development and execution of this unit, budget administration, hiring and managing staff as well as ongoing management and operations of this unit and its processes.

　　Principal responsibilities include:

　　Oversee the provision of Community Supports services.Identify, develop, and manage any additional programs and processes to identify and manage high risk members to improve members health outcomes and prevent hospitalizations.Create and manage referral processes:From Alliance staff (UM and CM), community providers, and self-referralsFrom CS ProvidersProvide assistance to CS Providers proceduresAssist in writing and implementing business requirements for any software systems that will be used in the authorization, referral and other processes.Implement methods to recruit and retain expert staff including hiring, developing, mentoring, training, and retaining competent staff.Monitor intake, referral, and authorization productivity.Perform regular audits of all staff disciplines to review detailed clinical information, analyze clinical documentation, determine medical appropriateness, and make clinically sound conclusions.Engage internal and external stakeholders in Community Supports processes, promote interdisciplinary collaboration, foster teamwork, and champion service excellence in keeping with organizational goals.Appropriately manage people, relationships, and processes to achieve maximum results.Identify improvement opportunities and provide solutions and feedback to LTSS Director.Complete and conduct annual performance evaluations with staff.Develop and manage the departmental budget and track monthly variances. Oversee expense and revenue utilization.Anticipate, identify, and analyze care issues and trends, make appropriate recommendations, develop and implement best practice pilot projects aimed at reducing medical costs and improving quality healthcare outcomes.Work collaboratively with the LTSS Director on refinement of metrics to evaluate effectiveness of Community Supports from clinical, utilization and financial outcomes.Work with the LTSS Director to develop short and long-term plans for CS related activities.For each Community Supports service offered:Develop, maintain, and monitor workflow processes.Contribute to reports of CS service outcomes.Provide quality care services measured by consistent achievement of professional standards and the satisfaction of customer expectations.Oversee the collection, analysis and report of CS performance data based on Department of Health Care Services (DHCS), National Committee on Quality Assurance (NCQA), Alameda County, state, and federal standards.Act as the subject matter expert (SME) on Community Supports offerings and provide education and promote understanding of community supports, social services, and quality improvement issues.Participate on compliance, finance, contracting, regulatory, and other multidisciplinary committees that foster organizatio al improvement.Ensure that all state and federal requirements are supported by the current program policies and IT platforms.Work closely with the Alliance LTSS and Case Management teams to identify medical and social services issues that have an impact on plan benefits and their administration.Review quality concerns identified through the QI process and oversee the implementation and monitoring of relevant corrective action plans.Prepare for and participate in regulatory audits and develop and monitor corrective actions plans.Oversee department workload and ensure that timely and effective adjustments are made to ensure timely service to members.Oversee the development of policies and procedures and any necessary community supports protocols.Administer a program for the development, preparation and maintenance of appropriate and required records, data, processes, policies and procedures.Complete other duties and special projects as assigned.ESSENTIAL FUNCTIONS OF THE JOB

　　Recruiting, supervising, and training of staff.Writing, reporting, administration, and analysis.Communicating effectively and efficiently internally and externally.Developing long and short-range strategic plans for case and disease management activities.Making verbal presentations.Leading and participating in internal and external committees and meetings.Complying with the organizations Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.PHYSICAL REQUIREMENTS

　　Constant and close visual work at desk or on the computer.Constant sitting and working at desk.Constant data entry using keyboard and/or mouse.Frequent use of telephone headset.Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.Frequent lifting of folders and other objects weighing between 0 and 30 lbs.Frequent walking and standing.Number of Employees Supervised: 10-15

　　MINIMUM QUALIFICATIONS:

　　EDUCATION OR TRAINING EQUIVALENT TO:

　　BSN or MSW required.Active and unrestricted licensed in the State of California as Registered Nurse, or Licensed Clinical Social Worker (LCSW) preferred.Administrative Masters Degree preferred (MPA, MBA, MSN, MPH or other applicable masters degree)Have a cleared TB test prior to or within seven days of hire.Current CPR and first aid card prior to or within six months of hire is preferred.MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

　　Three to five years healthcar