Senior Manager, Clinical Operations- Bakersfield 1.1

Description

Location: Bakersfield, CA 93309 (Onsite)

Department: Enhanced Care Management

Schedule: Monday-Friday 8am-5pm  

Benefits:

· Medical 

· Dental 

· Vision

· Simple IRA Plan

· Employer Paid Life Insurance

· Employee Assistance Program

Compensation:

The initial pay range for this position upon commencement of employment is projected to fall between $50.48 and $63.09.

However, the offered base pay may be subject to adjustments based on various individualized factors, such as the candidate's relevant knowledge, skills, and experience. We believe that exceptional talent deserves exceptional rewards. As a committed and forward-thinking organization, we offer competitive compensation packages designed to attract and retain top candidates like you.

Position Summary: 

The Senior Manager, Clinical Operations serves as an operational leader for the strategic development and execution of the integrated Enhanced Care Management (ECM) services within Universal healthcare MSO. Responsibilities include, but are not limited to, the development and execution operational goals, objectives, initiatives, and action plans to achieve outcomes by identifying and monitoring key service line targets and metrics. The Senior Manager, Clinical Operations is accountable for monitoring and improving ECM operational processes, along with training and performance management of ECM program staff to ensure all services are meeting or exceeding critical performance measures in health plan compliance, strategic goals, and mission and vision of the organization. This role requires strong leadership, strategic thinking, analytical, and problem-solving skills, and a commitment to delivering high-quality services. This position requires a high proficiency in using report software and data analytics to provide accurate and timely reports to the executive team and to utilize for program improvement.

Job Duties and Responsibilities: 

· Responsible for overseeing the day-to-day operations the Enhance Care Management (ECM) Department.

· Ensure the smooth and efficient function of the program by managing administrative tasks, ensuring adequate staffing levels within the department and implementing policies and procedures. 

· Monitors program performance metrics, identifies areas of operational improvement, and develops strategies to enhance operational efficiency and effectiveness.

· Lead the operational strategy and execution of the ECM program, managing resources and processes to deliver effective care management services.

· Supervise and provide direction to the ECM Clinical Manager and other operational staff, ensuring cohesive teamwork and program alignment.

· Develop, implement, and continuously improve workflows, policies, and procedures to ensure optimal program operations and compliance with federal and state regulations and health plan guidelines.

· Track and evaluate program metrics, including outreach, enrollment, patient outcomes, and cost-effectiveness, making data-driven decisions to enhance performance.

· Prepare regular reports on program status, performance outcomes, and key operational milestones for senior leadership.

· Foster strong partnerships with hospitals, healthcare providers, community-based organizations, health plans, and internal departments to ensure seamless care coordination and referrals.

· Coordinate with the Clinical Manager and interdisciplinary care teams to address member needs, reduce avoidable ED visits and hospital readmissions, and ensure timely service delivery.

· Serve as the primary liaison for external partners and stakeholders.

· Oversees the authorization process for ECM services, ensuring timely approvals, reduction of denials, and compliance with insurance requirements.

· Lead the development and monitoring of quality assurance processes, ensuring that care management services meet the highest standards.

· Develops and implements staff schedules, working with clinical manager in ensuring adequate coverage for all care management activities.

· Conducts regular staff meetings to disseminate information, address concerns, and facilitate collaboration. Fosters a positive work environment by promoting teamwork, professionalism, and open communication among staff members.

· Stay informed of regulatory updates and policy changes impacting Medi-Cal and Enhanced Care Management, adapting program operations as needed.

· Responsible for the Team Management, Staff Development, Stakeholder Engagement, Community Partnerships, Financial Management, and Program Compliance.

· Collaborate with RCM team and support billing/claiming processes, ensuring operational alignment with contractual requir