Pediatric Care Management and California Children's Services Manager (RN)

Location: Mariposa County, California; Merced County, California; Monterey County, California; San Benito County, California; Santa Cruz County, California

We have an opportunity to join the Alliance as the Pediatric Care Management and California Children's Services Manager (RN) leading the Pediatric Care Management and California Children's Services Department.

Reporting to the Care Management Director, this position:

• Manages and leads the Pediatric Care Management and California Children's Services (CCS) Unit, develops and adapts the Pediatric Care Management program to address needs, acts as a subject matter expert, and provides guidance related to care coordination and care management activities
• Provides management oversight related to Pediatric Care Management functions and departmental operations
• Performs program effectiveness evaluation
• Manages, supervises, mentors and trains assigned staff
• Collaborates with a variety of Alliance staff on special projects

ABOUT THE TEAM

The Care Management Department looks to support, connect, and empower members through community-based organizations and providers, in furtherance of improving health outcomes. Our mission is to coordinate care and empower members to achieve their health and wellness goals through collaboration and by facilitating member relationships with community providers. We serve the Alliance by creating a bridge between the Alliance, our communities, and individual members. We bring the voice of the member into the room when collaborating with our fellow departments at the Alliance and we assist the members in connecting the dots to successfully navigate options and resources for their care.

Pediatric Care Management unit is also about complex case management, but for our younger members. We work with the counties in line with California Children's Services Whole Child Model.

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here.

• Knowledge of:




• Principles and practices of clinical nursing
• Principles and practices of supervision and training
• Principles and practices of care management and coordination and utilization management
• Principles and practices of managed care
• Tools and techniques related to data analysis, and reporting
• CCS and the regulatory requirements related to CCS and the WCM program
• Some knowledge of Knox Keene, Medi-Cal, Title 22, and related regulations




• Ability to:
  
  
  
  • Train, mentor, supervise and evaluate the work of staff, promote an atmosphere of teamwork and cooperation, and motivate staff to achieve goals and objectives
  • 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
  • Manage the development and implementation of projects, systems, programs, policies and procedures
  • Analyze and interpret legal, regulatory and contractual language, policies, procedures and guidelines, and legislative and regulatory directives
  • Provide leadership, facilitate meetings, and attend in person meetings with community partners, providers, and hospitals
  
  
  
  
• Education and Experience:
  
  
  
  • Current and unrestricted license as a Registered Nurse issued by the state of California
  • Bachelor's degree in Nursing and a minimum of six years of experience in a health plan or patient care setting, which included a minimum of two years of experience supervising and training a multi-disciplinary health care team, two years of pediatric care management experience, and some experience in a care management capacity (a Master's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying
  
  
  
  

OTHER INFORMATION

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below.

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area

Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area