ABOUT US: We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve over 350,000 members in Santa Cruz, Monterey and Merced counties. To learn more about us, click here or check out this video.
WHAT YOU'LL BE RESPONSIBLE FOR Developing and managing an individualized intervention plan for members referred into the Care Management program with the goal of promoting optimal, achievable outcomes in the most cost effective and appropriate manner. You will work in conjunction with the interdisciplinary Care Management team to facilitate quality outcomes across the continuum by educating members, providers, external agencies, and internal departments and providing assistance in navigating the managed care system. You will participate in Quality Improvement efforts, to continually evaluate the Care Management Program’s effectiveness and its quality driven, cost effective achievable goals and outcomes for Alliance members.
ABOUT THE TEAM This is a new team forming in the Care Management Department as we, the Alliance, a Medi-Cal managed care plan, implement the Whole-Child Model (WCM), and incorporate California Children’s Services (CCS) covered services into our plan. CCS is a statewide program for children with special health care needs. The CCS services were previously “carved out” (not a covered benefit of our plan) and were coordinated by the respective counties in our contracted areas. We are working with each county in preparation for our July 1, 2018 implementation date to assume responsibility for payment, authorization and care coordination of primary and specialty services for CCS-eligible children and youth. To learn more about the WCH model, integration of CCS services and other resources, click here.
THE IDEAL CANDIDATE
Be excited about being a part of something new for the health plan, and acknowledge the challenge and opportunity that this time presents
Learn from our County partners as we implement this program, with a goal of a seamless transition for the families as we target our July 1st effective date
Be motivated to serve children with special health care needs and partner with their families while able to maintain professional boundaries in relationships that could be built from the time a member is in the NICU to the time they are 21
Be flexible in a changing and dynamic environment, and appreciate that each day will be a bit different
Be comfortable spending time on-site with the County during training and onboarding and then translating the knowledge and information back to us
WHAT YOU'LL NEED TO BE SUCCESSFUL
The principles and practices of case management including assessment, care/treatment planning, discharge planning and documentation
Medi-Cal and related policies and regulations
The principles and practices of health care, medical administration and health care systems, including managed care
Use pro-active customer service skills in handling complex and demanding situations
Advocate on behalf of the individual to assure quality of care and attainment of appropriate goals
Create, document, and implement intervention plans
Manage person who are non-compliant and or have behavioral health issues
Education and Experience:
Master’s degree in Social Work or similar field of study
Two years of Social Service experience in an acute care setting, community agency or managed care environment or an equivalent combination of education and experience which would provide the required knowledge, skills and abilities may be qualifying