Manager, Behavioral Health & Care Management

Position Summary/Position

Under the direction of the Behavioral Health & Care Management Director Leadership (BH&CM), the Manager, BH& CM is responsible for assisting in the development and implementation of the Member-centric Care Management (CM) and Care Coordination Programs including reviewing and revising the program description and policies and procedures. The Manager, BH&CM will provide direct supervision of their team which can include registered nurses, licensed vocational nurses, social workers (licensed and non-licensed) and support staff performing a variety of duties including care coordination, complex care management, and integrated care management for IEHP Members. The Manager, BH&CM is also responsible for promoting quality patient care outcomes and maintaining regulatory compliance, while supporting appropriate resource management along the continuum of care.

Major Functions (Duties and Responsibilities)

1. Oversee the integrated care management quality, achievement of whole health outcomes, operational compliance, and quality assurance functions within their assigned Team(s). Use their knowledge of regulatory and quality guidance such as the California Code of Regulations (Title 22, Section 51013), California Children’s Services, NCQA Standards for Complex Case Management & Population Health, Medi-Cal Program & Contract Requirements specific to case management, Dual Eligible contract program requirements and Health Risk Assessment compliance monitoring, to guide process improvement, workflow development, and standardized work.
2. Provide daily coaching of Team Members on integrated teams, routine presence in the Gemba and accountability to leader standard work.
3. Develop intervention recommendations for identified improvement opportunities and work with Compliance, Quality and BH&CM leadership to implement and monitor.  
4. Work in collaboration with Managers and Supervisors in BH&CM to design and maintain accountability to a skills development matrix so all Team Members of the integrated teams understand each other’s roles and have cross functional training.
5. Review and implement current and new regulatory requirements into policy, procedure, and practice. Review and update care management documents as needed such as:
    a. Policies and procedures to meet regulatory requirements and accreditation standards
    b. Quality Improvement Activities 
    c. BH&CM Program Descriptions
6. Support the Director(s) to establish team metrics and daily monitoring plan to do continuous review of metrics. 
7. Assume responsibility for the development of A3 when Integrated Care Teams are not achieving target metrics or metrics are trending in negative direction.
8. Lead quality improvement studies related to NCQA and regulatory QIPs (i.e., CMS)
9. Collect, evaluate, and report data on BH&CM activities and perform root cause analyses of identified areas of non-compliance, and collaboratively develop corrective action plans with BH CM leadership colleagues.
10. Provide consultation for the non-licensed Team Members when discussing tasks of a clinical nature.
11. Develop effective relationships with co-workers, direct reports, supervisors, and community partners, modeling excellent interpersonal skills and collaboration in working toward position duties and goals.
12. Effectively increase and maintain strong employee engagement with assigned Team Members, as well as engage with other BH CM leaders in the development and implementation of employee engagement initiatives.
13. Collaboratively develop effective workflows, processes, and practices to provide  Members with timely, efficient, and effective care coordination, case management, linkage to referrals, transitions of care and other necessary services.
14. Ensure the BH&CM Teams work effectively with their assigned physicians, PCP offices, and contracted vendors.
15. Work with the department Analysts as well as other Health Informatics leaders at IEHP to develop metrics, reports and dashboards that facilitate continuous quality improvement in the delivery of BH&CM.
16. Professionally and collaboratively work with internal departments, to resolve issues and establish workflow processes to ensure delivery of high-quality services.
17. Professionally represent IEHP at meetings, conferences, learning convenings, and other training activities.
18. Demonstrate commitment to IEHP’s Mission, Vision, and Values by modeling, developing, and engaging MVV activities and events with Team Members.  

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Experience Qualifications

Five (5) or more years of experience in a health care delivery setting and serving in a supervisory leadership capacity (Supervisor or Manager). Advanced knowledge and working experience with State and Federal requirements (DHCS, CMS, DMHC) and quality standards (NCQA) in Managed Care context. Advanced knowledge and working experience in teams consisting of behavioral health, care management and Team Members dedicated to addressing social determinants of health.

Preferred Experience

Experience in a managed care organization serving Medicaid and/or Medicare membership preferred. 

Education Qualifications

In lieu of a Bachelor’s degree, one of the following applicable scenarios may be considered:

- Candidate with an active, unrestricted, and unencumbered Registered Nurse (RN) issued by the California BRN without a Bachelor’s degree will require four (4) years of additional relevant work experience. This experience is in addition to the minimum years listed in the Experience Requirements above.  
- Candidate with an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians without a Bachelor’s degree will require six (6) years of additional relevant work experience. This experience is in addition to the minimum years listed in the Experience Requirements above.

Internal Candidates Only: In lieu of the required degree, a minimum of five (5) years of IEHP work experience in Health Services division is required for this position. This experience is in addition to the minimum years listed in the Experience Requirements above.

Preferred Education

Master’s degree from an accredited institution preferred.

Professional Certification

Certification in Healthcare Compliance (CHC), Certified Case Manager (CCM), Certified Professional in Healthcare Quality (CPHQ), Academy of Certified Social Workers (ACSW) is preferred.

Professional Licenses

Possession of one (1) of the following active, unrestricted, and unencumbered clinical licenses issued by appropriate California state board preferred:
- Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians.
- Registered Nurse (RN) license issued by the California BRN.
- Clinical Social Worker (LCSW) license or Marriage and Family Therapist (LMFT) license issued by the California Board of Behavioral Sciences.

Drivers License Required

Knowledge Requirement

Working knowledge of Medicaid (Medi-Cal), Centers for Medicaid & Medicare Services (CMS) regulations and National Committee for Quality Assurance (NCQA) requirements in managed care preferred. Demonstrate proficiency with all electronic medical management systems (e.g., Cisco, Care Prominence, MediTrac, Super Search and Web Portal) to assist in training of new Team Members.

Skills Requirement

Problem-Solving Skills. Identify and resolve problems. Report Analysis Skills. Comprehend and analyze statistical reports, aggregate data, make recommendations. Effective engagement and skill development skills to support strong, cohesive, productive Teams. Effective written and oral communication skills. Advanced reasoning skills.

Abilities Requirement

Proven ability to:
- Establish and maintain a constructive relationship with diverse Members, management, employees, and vendors.
- Have effective time management and prioritize multiple tasks.
- Collect data, establish facts, draw valid conclusions, and implement solutions. 
- Work in a fast-paced environment.

Commitment to Team Culture

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; talk or hear; and taste or smell. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus. Occasionally employee may require field visits.

Position is eligible for Hybrid work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.

Work Model Location

Physical Requirements