Manager MediCal Program

Sacramento, California
Feb 02, 2024
Feb 14, 2024
Job Summary:

Plans, implements and administers the functions, activities and related initiatives of the Northern California regions Medi-Cal program. Oversees a multi-disciplinary team that coordinates the continuum of care services for members of Medi-Cal or other state funded programs to ensure members proceed efficiently through the course of services. Recommends strategies for the programs development to ensure compliance with state and federal regulations and alignment with organizational goals.

Essential Responsibilities:

  • Manages a team of licensed and non-licensed staff responsible for coordinating the continuum of care services for members of Medi-Cal or other state funded programs to ensure members proceed efficiently through the course of services. Staff includes patient care coordinators, social workers and LVNs acting as care coordinator assistants performing a range of services for the overall care plan for members including member outreach, administering risk assessments to identify medical and psychosocial needs, creating care plans and initiating referrals to KP physicians and services based on members medical and psychosocial needs, assisting members in obtaining Kaiser and community support resources, monitoring members progress, performing intervention actions on behalf of members , helping members understand post-discharge procedures and other member support services. Sets team schedules and recommends changes to the teams operational model to achieve ongoing efficiency. Establishes and assures adherence to budgets, schedules, work plans, and performance requirements.

  • Leads the development and implementation of program standards, policies and procedures to ensure the Northern California Regions Health Plans Medi-Cal contracts meet state and federal rules and contractual requirements. Coordinates program development work activities. Provides training and education on regulatory requirements, policies and procedures to teams and stakeholders. Administers the program focused on maintaining a state of continuous regulatory readiness. Works with the medical director for The Permanente Medical Groups (TPMG) Regional Medi-Cal department and Kaiser Health Plans (KFHP) Regional Executive Director of Medi-Cal Strategy to ensure alignment of program policy and approach between TPMG and KFHP.

  • Develops strategic partnerships with county and State agencies. Acts as KP Regional liaison to external organizations and the California State Medi-Cal regulatory agency to ensure ongoing operational compliance with Medi-Cal program rules for the Seniors and Persons with Disabilities program and other similar programs. Meets regularly with local health plan operations management team members to ensure ongoing operational compliance and to remove barriers to achieving compliance.

  • Collaborates with Southern CA Region on approaches that create efficiencies and foster an organizational response representing both Regions to the State.

  • Creates executive level reports for Kaiser leaders and external outside regulatory and monitoring agencies regarding program performance, trends, barriers to ensure alignment with regional business objectives and regulations.

  • Performs other duties as required.

  • Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees.