Organization: Partnership HealthPlan of California
Location: Fairfield, CA
Date Job Posted: September 29, 2021
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Regulatory Performance Manager - Care Coordination
Job ID 2021-2044 FLSA Status Exempt
To plan, manage and evaluate clinical department and/or PHC delegate(s) performance and compliance under DHCS and NCQA regulations. Responsibilities include annual DHCS Medical Audits for Care Coordination, delegation oversight and monitoring activities for applicable providers and entities, and on-going stewardship of NCQA activities to support PHC’s continued NCQA Accreditation.
Education and Experience
Bachelors of Science in Nursing preferred; minimum five (5) years acute care experience, two (2) years managed care experience; or equivalent combination of education and experience. Minimum one (1) year prior experience in a leadership or management role.
Special Skills, Licenses and Certifications
Working knowledge of Medi-Cal (DHCS) program and/or NCQA Health Plan guidelines. Current California Registered Nurse License. Certifications in chosen field such as advance practice nursing or case management. Strong knowledge of nursing standards in both inpatient and outpatient settings. Strongly leadership, program evaluation, auditing and management skills. Thorough knowledge of Care Coordination, Discharge Planning, Case Management and Utilization Review within a managed care environment. Familiarity of business practices and protocols accessing data sets and information using automated systems. Ability to work within an interdisciplinary structure and function independently in a fast-paced environment while managing multiple priorities and deadlines. Strong organizational skills required. Computer literacy and proficiency. Valid California Driver's License and proof of current automobile insurance compliant with PHC's policies are required to operate a vehicle and travel for company business.
Performance Based Competencies
Excellent written and verbal communication skills in English. Demonstrated experience and ability to build effective working relationships and to represent the department effectively in order to accomplish goals. Ability to manage multiple concurrent projects and maintain a work pace appropriate to the workload. Ability to assist individuals in recognizing and solving problems. Ability to supervise, train, motivate, provide guidance to staff.
Work Environment And Physical Demands
Daily use of multi-line telephone and computer for most of the day. Cubicle work station. Ability to use a computer keyboard. Must be able to lift, move, or carry objects of varying size, weighing up to 10lbs.
All HealthPlan employees are expected to:
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change