Supervisor - Care Management

Supervisor - Care Management

Department: HS - ACM

Employment Type: Full Time

Location: 1600 Corporate Center Dr., Monterey Park, CA 91754

Reporting To: Romaine Segura

Compensation: $85,000 - $980,000 / year

Description

What You'll Do

• Provide daily supervision of care management teams, ensuring adherence to ambulatory care management, model of care policies, procedures and regulatory requirements.
• Oversee clinical care management services across the continuum, supporting staff performance and clinical quality.
• Ensure consistent application of policies and implement corrective or disciplinary actions when needed.
• Other projects and duties as assigned by the Clinical Leadership team.

• Monitor and support implementation of the Astrana Health care management process, including training and documentation.
• Review health plan reports to identify members needing care coordination or targeted interventions.
• Ensure all care management activities comply with NCQA standards, CMS, health plan and state regulations, and internal protocols.

• Support development and review of individualised care plans and integrate care strategies across disciplines.
• Lead or participate in Multi-Disciplinary Care Team (MDT) meetings, providing operational insight and solutions for complex cases.
• Engage with network PCPs, specialists and vendors to ensure timely, appropriate care coordination and service use.
• Collaborate with Utilisation Management, Inpatient Case Management and Ambulatory Care to ensure continuity across care transitions.
• Monitor and evaluate case management plans, modifying as needed to meet regulatory requirements, coordinate services, evaluate treatments, intervene in crises and provide support.

• Conduct internal audits of ambulatory care management cases and provide feedback and coaching to staff.
• Educate and support staff on documentation standards, best practices and quality improvement opportunities.
• Assist with submission deliverables for health plan audits.

• Conduct performance evaluations of care management staff, including audits of care plans, assessments and documentation.
• Monitor staff attendance and ensure accountability to organisational expectations.
• Provide mentorship and training to foster excellence, collaboration and continuous improvement.
• Oversee hiring, onboarding and training of new staff.
• Maintain staff timekeeping and personnel records.
• Other duties as assigned.

Qualifications

• Active RN or LVN unrestricted license required
• Minimum of 3+ years of care management experience in a medical group, IPA, or HMO setting
• Associate Degree of Science in Nursing

• Bachelor’s degree in healthcare related fields
• Knowledge of NCQA standards, Model of Care and Case Management requirements, CMS and state regulations, and HMO/ACO model structures
• Strong communication, leadership, and critical thinking skills
• Proven ability to work cross-functionally with clinicians, leadership, and administrative staff to drive outcomes
• Experience in managing diverse teams and leading quality-focused initiatives
• Skilled with the use of the Microsoft Office suite of products and the ability to use and effectively learn and navigate other computer systems

Environmental Job Requirements and Working Conditions

• Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr., Monterey Park, CA 91754.
• The annual total compensation target pay range for this role is: $85,000 - $98,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.