Established in 1997, San Francisco Health Plan (SFHP) is a an award winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco county. San Francisco Health Plan is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 145,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. SFHP was designed by and for the residents it serves, and takes great pride in its ability to accommodate a diverse population that includes young adults, seniors, and people with disabilities.
Reporting to the Director, Care Management, the Manager, Care Management is responsible for the oversight and operation of three clinical teams (LCSWs, RNs and Community Coordinators) that provide interdisciplinary care management services to approximately 400 of SFHP’s highest risk members. The Care Management department maximizes the social work principles that individuals are complex and one must assess and address all domains, including individual preference, in order support lasting change in behavior. This position will oversee the daily operations of the clinical teams and ensure that all programmatic and regulatory requirements are met. Care Management is an evolving department that strives to be data driven and outcomes oriented. A fundamental part of this position will be implementation of new Care Management initiatives within SFHP and coordination with community and network partners. In order to achieve these goals, the Manager will partner with the Senior Care Management Program Manager to ensure that all regulatory requirements are met and monitored.
WHAT YOU’LL DO
- Oversight and performance of Care Management clinical teams, including adherence to department standards of documentation and auditing and tracking short term and long term goals.
- Both within and outside of SFHP, the manager will advocate for Care Management goals, keep tasks within the department’s scope of work, and optimize care for our members.
- Attending clinical and operational meetings and evaluating ongoing meeting strategy and purpose.
- Under the guidance of the Director, Care Management creates and executes strategic direction of clinical programs and staff.
- Act as an escalation point for clinical and operational issues from staff, members and providers.
- Collaborate with Director on the development and management of the department budget. The manager will be responsible for administration and monitoring of the budget.
- Maximize partnership with Senior Program Manager to ensure all projects are appropriately resourced and executed successfully.
- Develop and track meaningful metrics to highlight the productivity and success of the clinical teams.
- Provide weekly supervision to all direct reports
- Actively participate in all management level meetings, including: Care Management Team, Health Services Management Team and SFHP Management Team
- Collaborate effectively with other departments including, but not limited to: Provider Network Operations, Information Technology, Business Intelligence, Utilization Management, Customer Service, Compliance, Pharmacy and Marketing.
- Actively work with Health Services management to integrate departmental workflows and care provided to our members.
- Periodically present to both internal and external stakeholders on Care Management program updates and outcomes.
- Ensure that our care management system, Essette, is being optimized to support new and evolving programs.
- Build and leverage partnerships with external providers and stakeholders. as needed for implementation of programs, and developing formal partnerships through contracts and/or data sharing.
- In coordination with the Delegation Oversight team, develop and participate in yearly auditing of Delegated Medical Groups and act as the Care Management point of contact.
- Staff Training schedule development and oversight in collaboration with the Clinical Supervisors.
- Develop and implement a staff hiring and retention strategy in collaboration with the Clinical Supervisors.
- Understand and execute all regulatory requirements for Care Management from all governing bodies, including: Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC) and National Committee for Quality Assurance (NCQA).
- Responsible for development and management of all department Policies and Procedures, clinical workflows and desktop procedures.
WHAT YOU’LL BRING
- Bachelor's degree in policy, administration, social work, nursing or other related field; Master's preferred
- At least 3 years of care management/case management experience in direct care or supervisory setting
- Minimum of 3-5 years supervisory or staff management experience
- Ideal candidate will have experience in non-profit or community work and experience with direct patient care
- PC proficiency required; MSOffice skills (Outlook, Word, Excel, PowerPoint)
- Strong communication skills
- Experience in working with data to drive team and process
San Francisco Health Plan is an Equal Opportunity Employer (EOE) M/F/D/V
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.