Manager, Behavioral Health & Care Management

Date: Jun 22, 2022

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 7516 

 

Position Summary/Position

 

Under the direction of the Director of Integrated Care, the Behavioral Health & Care Management Manager is responsible for assisting in the development and implementation of the Member-centric Care Management (CM) Programs including reviewing and revising the program description and policies and procedures. The BH & CM Manager will provide direct supervision of his/her team which includes registered nurses, licensed vocational nurses, behavioral health clinicians and clinical support staff performing a variety of duties including care coordination, complex case management, and integrated care management for IEHP Members. The BH & CM Manager 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.
2. Guide process improvement, workflow development, and standardized work through the use of their knowledge of regulatory and quality guidance such as in 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.
3. Responsible for daily coaching of Team Members on integrated teams, routine presence in the Gemba and accountability to leader standard work.
4. Develop intervention recommendations for identified improvement opportunities and work with Compliance, Quality and CM leadership to implement and monitor.
5. Work in collaboration with Managers and Supervisors in Behavioral Health & Care Management to design and maintain accountability to a skills development matrix so all members of the integrated teams understand each other’s roles and have cross functional training.
6. Responsible to review and implement current and new regulatory requirements into policy, procedure, and practice. Review and update care management documents as needed such as:
  i. Policies and procedures meet regulatory requirements and accreditation standards
  ii. Quality Improvement Activities
  iii. Care Management Program Descriptions
7. Accountable to ensure that CCM and Population Health NCQA Standards (relative to BH & CM) are implemented and monitored for continuous improvement.
8. Support the BH & CM, Directors to establish team metrics and daily monitoring plan to do continuous review of metrics.
9. Assume responsibility for the development of A3 when Integrated Care Teams are not achieving target metrics or metrics are trending in negative direction.
10. Responsible for leading quality improvement studies related to NCQA and regulatory QIPs.
11. Collect, evaluate, and report data on Behavioral Health & Care Management activities and perform root cause analyses of identified areas of non-compliance, and collaboratively develop corrective action plans with CM leadership colleagues.
12. 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.
13. Effectively increase and maintain strong employee engagement with assigned staff, as well as engage with other BH & CM leaders in the development and implementation of employee engagement initiatives.
14. 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.
15. Ensure the BH & CM Teams work effectively with their assigned physicians and PCP offices.

Major Functions (Duties and Responsibilities) Cont

 

16. Work with the department Business 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 CM.
17. Professionally and collaboratively work with Utilization Management, Enhanced Care Management Teams, Member Services, Pharmacy and Behavioral Health & Care Management Department leaders, to resolve issues and establish workflow processes to ensure delivery of high-quality services.
18. Professionally represent IEHP at conferences, learning convenings, and other training activities.
19. Appropriately escalate clinical issues that are beyond the scope of nursing practice. Work collaboratively with:
  i. BH & CM Directors to monitor Integrated Care Team program effectiveness through established metrics
  ii. BH & CM Directors to establish and monitor standard work and modify when metrics are not being met
  iii. BH & CM Manager for Regulatory & Quality Compliance, Behavioral Health & Care Management Managers and Quality & Training Managers to ensure processes meet regulatory compliance and quality standards including identifying department training needs to align workflow processes with regulatory and quality compliance & audit readiness
  iv. BH & CM, Compliance, Regulatory & Quality, Learning & Development, and Policy & Regulations Operations leadership to ensure BH & CM program is aligned with and supports inter-departmental initiatives
20. Attend, participate in, and/or lead key meetings and workgroups relative to Integrated Care Management Team’s operations & functions.
21. Lead and supervise day-to-day Behavioral Health & Care Management team functions to ensure high-quality, cost-effective services to Members, and compliance with regulatory requirements.
22. Provide timely direction and support for BH&CM Team to ensure adherence to regulatory standards.
23. Responsible for the leadership, guidance and development of Team Members assigned to Regional Integrated Care Management teams.

Supervisory Responsibilities

Leader: Administers Hires, Terminations, and Performance Reviews

Experience Qualifications

 

Three (3) or more years of utilization management/case management in a health care delivery setting and serving in a supervisory leadership capacity (Supervisor or Manager). Expert knowledge and working experience with State and Federal requirements (DHCS, CMS, DMHC) and quality standards (NCQA) in Managed Care context. Expert 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

 

Bachelor’s degree from an accredited institution required. 
Significant experience may be considered in lieu of degree: In lieu of a degree, a minimum of eleven (11) years of relevant work experience is required.

Preferred Education

 

Master’s degree in Social Work, or a related field (i.e. MPH, MA, MSN, MBA) from an accredited institution preferred.

Professional Certification

 

Certification in Compliance (CHC), CCM, CPHQ is preferred. 

Professional Licenses

Drivers License Required

Yes, must have a valid California Driver's License.

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.

Skills Requirement

 

Demonstrate proficiency with all electronic medical management systems (e.g. Cisco, MHK, MediTrak, Super Search and Web Portal) to assist in training of new staff members. Problem-Solving Skills: Identify and resolve problems. Report Analysis Skills: Comprehend exemplary leadership for all assigned BH & CM Team members and ensure that Team Members are supervised and given every opportunity to succeed in their positions. Effective engagement and skill development skills to support strong, cohesive, productive teams. Effective written and oral communication skills.

Abilities Requirement

 

Ability to establish and maintain a constructive relationship with diverse Members, management, Team Members, and vendors. Reasoning Skills: Ability to prioritize multiple tasks; advanced reasoning skills, collect data, establish facts, draw valid conclusions, and implement solutions. Effective time management and the ability to work in a fast-paced environment. Model the importance of Member experience and engagement and engage with other leaders at IEHP in developing and implementing Member experience improvement activities in accordance with Department and HR policies.

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

Work Model Location

Hybrid

Physical Requirements

Keyboarding: Traditional - FREQUENTLY
Keyboarding: Touch-Screen - FREQUENTLY
Keyboarding: 10-Key - FREQUENTLY
Hearing: One-on-One - FREQUENTLY
Communicate: Information/ideas verbally - FREQUENTLY
Near Visual Acuity - FREQUENTLY
Sitting - CONSTANTLY
Lighting - CONSTANTLY
Indoors - FREQUENTLY
Regular contacts: co-workers, supervisor - FREQUENTLY
Memory - FREQUENTLY
Understand and follow direction - FREQUENTLY
Regular and reliable attendance - CONSTANTLY

 

Starting Salary: $103,708.80  - $132,225.60  

Pay rate will commensurate with experience

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 7,000 and a team of more than 2,500 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles