*There is one position available and can be located in our Scotts Valley, Merced or Salinas office.
ABOUT US: We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve approximately 350,000 members in Santa Cruz, Monterey and Merced counties. To learn more about us, click here or check out this video.
WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Care Management Director, you will oversee the Pediatric Case Management Program and serve as the organizational expert on pediatric health programs and services, including the California Children’s Services (CCS) program. This is a new position at the Alliance, and you will initially prioritize overseeing the design and integration of the CCS program to help move us towards a fully integrated Whole Child Model of services. You will also be responsible for determining appropriate staffing levels, including co-located staffing, as well as workflows to assure a smooth transition of care for CCS-eligible children. You will also maintain oversight and compliance with contracts and MOUs with our county partners to ensure coordination of care. You will evaluate program effectiveness and maintain current knowledge of regulatory agencies and related requirements related to Case Management, such as Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC), and Managed Risk Medical Insurance Board (MRMIB). You will manage, supervise, mentor and train assigned staff, both clinical and non-clinical, and will work collaboratively with Alliance staff on special projects such as HEDIS, DHCS/DMHC audits and provider training.
ABOUT THE TEAM This is a new team forming in the Care Management Department as we, the Alliance, a Medi-Cal managed care plan, implement the Whole-Child Model (WCM), and incorporate California Children’s Services (CCS) covered services into our plan. CCS is a statewide program for children with special health care needs. The CCS services were previously “carved out” (not a covered benefit of our plan) and were coordinated by the respective counties in our contracted areas. We are working with each county in preparation for our July 1, 2018 implementation date to assume responsibility for payment, authorization and care coordination of primary and specialty services for CCS-eligible children and youth. To learn more about the WCH model, integration of CCS services and other resources, click here.
WHAT YOU'LL NEED TO BE SUCCESSFUL • Knowledge of: - Principles and practices of case management - Principles and practices of supervision and training - Concepts and guidelines related to prepaid health care - Tools and techniques related to program and project management • Ability to: - Organize and prioritize the work of others, delegate effectively, and follow up on work assignments - Act as a technical resource and explain regulations, processes, and programs related to area of assignment - Provide leadership and facilitate meetings - Plan, organize and lead data collection activities - Foster effective working relationships, influence others and build consensus with individuals at all levels in the organization • Education and Experience: - Current and unrestricted license as a Registered Nurse issued by the State of California and a Bachelor’s degree in Nursing OR a Master’s degree in a healthcare related field. - A minimum of five (5) years of experience in a patient care setting in the area of assignment (adults or pediatrics), which included a minimum of two (2) years of experience supervising and training clinical staff, one (1) year of case management experience, and some experience in a care management capacity or any combination of education and experience which would provide the required knowledge, skills and abilities may be qualifying.
BENEFITS: • Medical, Dental and Vision Plans • Ample Paid Time Off • 11 Paid Holidays per Year • 401(a) Retirement Plan • 457 Deferred Compensation Plan • Robust Health and Wellness Program • Fresh Fruit Delivery • Electric Vehicle Charging Stations • And many more!