Case Management Director jobs in Modesto, CA

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

• Conducts initial review for selected members, triages as appropriate.
• Assesses psychosocial factors that may have an effect on health or recovery for identified members.
• Develops social service care plans in partnership with member, his/her provider, and HPSJ staff.
• Collaborates with member, his/her family, caregiver, and internal and external resources to ensure understanding of and compliance with care plans.
• Provides and coordinates resource contacts, and/or referrals to appropriate professional or community resources.
• Monitors and evaluates progress at appropriate intervals; conducts appropriate interventions.
• Assists RN case managers and concurrent review nurses with case management, and discharge planning and other member transition needs.
• Assist CM & CCRN in assessing members for Mental Health/Behavioral needs and refer to appropriate resources to meet needs.
• Performs community outreach for selected members as assigned.
• Supports and advises member on self-advocacy efforts.
• Documents activities in appropriate HPSJ system(s) according to standards; maintains records according to standards.
• Tracks data as required; compiles data for, produces and submits routine reports.

• Produces work that is accurate and complete.
• Produces the appropriate amount of work.
• Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
• Rebounds from setbacks and adversity when facing difficult situations.
• Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
• Strong psychosocial assessment skills.
• Basic knowledge of chronic and acute disease and how they impact health conditions and social functioning.
• Strong knowledge of and proficient skills in administering protocols.
• In-depth knowledge of community resources related to healthcare.
• In-depth knowledge of medical policy benefits and exclusions.
• Ability to read, interpret and apply complex written regulations, guidelines and other materials; ability to read and interpret basic clinical information.
• Strong analytical and assessment skills.
• Strong problem-solving skills.
• Basic negotiation skills.
• Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
• Ability to use tact and diplomacy to diffuse emotional situations.
• Strong oral and written communication skills, with the ability to communicate professionally to diverse individuals inside and outside of HPSJ, effectively explain complex information and document according to standards.
• Strong customer service skills.
• Ability to work independently and as part of a team.
• Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.
• Basic skills in Word and Excel.
• Ability to enter data into and navigate through multiple databases.
• Ability to speak and be understood in English.
• Ability to handle confidential information with appropriate discretion.

• Proficient (as defined by HPSJ’s Cultural and Linguistics Program) in one of HPSJ’s threshold languages.
• Basic knowledge of the principles, practices and regulatory requirements of managed care.
• Knowledge of Medi-Cal or other government sponsored programs and regulations as they apply to social work.

• Bachelor’s Degree in Social Work, Psychology or other fields related to social services.
• At least three years as a social worker in a health care setting; OR.
• Equivalent combination of education and experience.

• Experience working with Medi-Cal and other government sponsored programs.
• Experience working in a managed care setting.

• Competitive salary
• Robust and affordable health/dental/vision (90% paid medical for employees and 100% paid dental/vision for employees) with choices in providers
• Generous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
• CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
• Two flexible spending accounts (FSAs)
• Employer-Paid Term Life and AD&D Insurance
• Employer-Paid Disability Insurance
• Employer-Paid Life Assistance Program
• Health Advocacy
• Supplemental medical, legal, identity theft protection
• Access to exclusive discount mall
• Education and training reimbursement in addition to employer-paid elective learning courses.
• A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
• A shorter commute – if you’re commuting from the Central Valley to the Bay Area.
• Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.

HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics, or is associated with anyone who has or is perceived to have these characteristics.

Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.