Supervisor, Enhanced Care Management

　　Job Category: Clinical

　　Department: Care Management

　　Location:

　　Los Angeles, CA, US, 90017

　　Position Type: Full Time

　　Requisition ID: 10717

　　Salary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.)

　　Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

　　Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

　　Job Summary

　　The Clinical Supervisor of Enhanced Care Management (ECM) is responsible for monitoring the ECM clinical staff's daily work and activities including but not limited to ensuring proper staffing and coverage, monitoring and evaluating departmental operations to ensure optimal efficiency and effectiveness. The position also assist in triaging identified issues/problems and forming resolution within the scope of work. Escalates appropriate issues to the senior management. The Supervisor will oversee the quality and effectiveness of service delivery through regular supervision and monitoring of client care documentation including assessments, care plans, outcome measures and progress notes. Ensures timely and high-quality documentation of services by assigned staff in accordance with all agency and contractual requirements.

　　This position is responsible in assisting and developing a successful and cohesive unit, with high level of productivity and accuracy to achieve the department's overall performance metrics. . This position is also responsible for ensuring all functions are operating in accordance with the organization's mission, values and strategic goals, which are focused on continuous improvement; and are provided in a manner that is responsive and sensitive to the needs of L.A. Care's culturally diverse membership.

　　The position supervises all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.

　　Duties

　　Supervise clinical ECM staff , including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.

　　Recommends process improvement measures to achieve department's performance measures outcomes and goals. Plans and directs ECM activities according to ECM Policy Guide, Model of Care, and policy and procedures to provide timely, quality care and services to members and the ECM providers

　　Assists in the development of training tools, and implements training plan for staff to support high quality, culturally responsive services. Oversees staff's performance, identifies and communicates areas that needs performance management to ensure compliance with regulatory requirements, policies and procedures.

　　Participates in regular meetings with managed care program, other contract liaisons, and community partners. Seeks opportunities to build strong relationships with health care providers, local and community organizations, government agencies to support enrolled members. Supports assigned staff to provide services that are clinically appropriate, culturally respectful, in partnership with stakeholders.

　　Develop and maintain positive working relationships with all business partners to ensure optimum member care and ECM provider satisfaction. Serves as a leader and role model as well as technical and informational resource for staff and peers. Foster a culture that encourages employee contribution to ensure that the department maintains an environment in which quality flourishes and recommends resources to reach new standards.

　　Ensures confidentiality and maintenance of client records in compliance with HIPAA, CII Policies and Procedures and licensure regulations.

　　Duties Continued

　　Maintains knowledge of program standards and policies as developed by the agency, licensing and other governing bodies; develops personal and professional knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the art practices; participating in in-service programs.

　　Improves health literacy by providing chronic medical and behavioral health education to members and families. Facilitates communication between members and providers by identifying health and wellness goals to incorporates into health action and shared care plans. Receives, identifies, and follows-up with treatment and medication alerts.

　　Ensures smooth transitions of care by coordinating member admission and discharges with hospitals. Conducts medication reconciliations with input from the providers Tracks and assures required assessments and screenings are performed, including comprehensive health assessments and shared care plans.

　　Maintain all assigned reporting responsibilities. Conducts regular audit activity via department's performance reporting standards to maintain quality care of members and compliance to regulatory requirements. Assures the accuracy of ECM audit reports and department proficiency in maintaining regulatory standards and time frames. Provides reports to manager to identify trends and improve work flow process.

　　Ensure department compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations relating to protection of personal history information (PHI).

　　Perform other duties as assigned.

　　Education Required

　　Master's degree in Social Work OR Associates Degree in Nursing in Social Work

　　Associate's Degree in Nursing for Registered Nurses

　　Education Preferred

　　Bachelor's Degree in Nursing

　　Experience

　　Required:

　　Minimum of 5 years of recent care management experience in a managed care setting, such as a health insurance environment and/or experience as care manager in a community based organization with at least 2 years of leading a process, program or staff or supervisory/management experience.

　　Equivalency: Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.

　　Preferred:

　　Previous care management experience in auditing/oversight/performance management.

　　Skills

　　Required:

　　Working knowledge of Medi-Cal and Medicare regulations.

　　Current knowledge of clinical standards of care and disease processes, and community resources

　　Excellent verbal and written communicating skills; excellent interpersonal skills

　　Ability to clinically analyze the most complex cases involving highly acute physical health, behavioral health, complex/catastrophic and/or psychosocial issues to determine the most effective member-centered interventions.

　　Proficiency in Microsoft Office MS Office applications

　　Excellent organizational, time management and interpersonal skills.

　　Maintain confidentiality in compliance with all Health Insurance Portability and Accountability Act (HIPAA) requirements

　　Ability to solve complex issues and identify creative solutions with external agencies

　　Excellent project management skills.

　　Ability to handle confidential information.

　　Licenses/Certifications Required

　　Licensed Clinical Social Worker (LCSW); Current and unrestricted California License or Registered Nurse (RN); current and unrestrited California License.

　　Licenses/Certifications Preferred

　　Certified Professional in Utilization Review (CPUR)

　　Certified Case Manager (CCM)

　　Required Training

　　Physical Requirements

　　Light

　　Additional Information

　　Please note that a Licensed Clinical Social Worker is only required when Master's Degree in Social Work. Licensed Clinical Social Worker not required with Associate's or Bachelor's Degree in Nursing.

　　Preferred:

　　Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.

　　Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

　　L.A. Care offers a wide range of benefits including

　　Paid Time Off (PTO)

　　Tuition Reimbursement

　　Retirement Plans

　　Medical, Dental and Vision

　　Wellness Program

　　Volunteer Time Off (VTO)