Senior Clinical Care Manager

Make a difference in the lives of others! Join HPSM as a Senior Care Manager and play a vital role in improving healthcare outcomes for members with complex medical and psychosocial needs. You’ll work closely with members and their care teams to develop individualized care plans, coordinate services, and ensure the delivery of high-quality, efficient care. This role also serves as a clinical subject matter expert, providing guidance on complex cases and supporting program development within the Integrated Care Management (ICM) model.

Key Responsibilities

• Manage a panel of assigned members, conducting comprehensive assessments to identify physical, psychosocial, environmental, and safety needs.
• Develop and implement member-centered care plans in collaboration with the member, their family, primary care provider, and care team.
• Apply evidence-based clinical guidelines and risk stratification to guide case management interventions.
• Provide ongoing support by coordinating with internal HPSM teams (e.g., inpatient/outpatient UM, pharmacy) to ensure effective service delivery.
• Identify and support members with complex medical and behavioral health needs, ensuring appropriate assessments, screenings, and care planning.
• Facilitate interdisciplinary team (IDT) meetings, clinical huddles, and community partnerships to enhance care coordination and avoid service duplication.
• Maintain timely and accurate documentation in the electronic medical record (EMR) within 48 hours of contact.
• Offer cross-coverage support to other care management teams and provide consultation on complex cases.
• Make referrals to internal departments, community-based organizations, and government agencies as needed.
• Educate members, caregivers, and providers on healthcare benefits, medications, and available resources.
• Support quality improvement initiatives, audits, NCQA accreditation, and compliance activities.
• Contribute to program development and process improvements within the ICM model.

Requirements

These are the qualifications typically needed to succeed in this position. However, you don’t need to meet every requirement to apply. 

Education and Licensure

• Bachelor’s degree in Nursing (BSN) or Master’s in Social Work (MSW) required.
• Valid California RN or LCSW license required.
• Certified Case Manager (CCM) or additional clinical certifications preferred.

Experience

• Minimum three (3) years of clinical case management experience in a medical or behavioral health setting.
• Experience with Medicare/Medi-Cal populations and complex care management preferred.

Skills and Abilities

• Strong communication and collaboration skills to engage effectively with members, care teams, and community partners.
• Ability to work independently, prioritize tasks, and adapt to evolving healthcare needs.
• Experience using Microsoft Office Suite and electronic medical records (EMR) systems.
• Bilingual skills (Spanish, Tagalog, or Chinese) highly preferred.
• Valid driver’s license, personal vehicle, and proof of insurance required.

Benefits

Excellent benefits package includes:

• HPSM-paid premiums for employee’s medical, dental and vision coverage (employee pays 10% of each dependent’s premiums)
• Fully paid life, AD&D and LTD insurance
• Retirement plan (HPSM contributes equivalent of 10% of annual compensation)
• 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year
• Tuition reimbursement plan
• Employee wellness program

It is HPSM's policy to provide equal employment opportunity for all applicants and employees.  HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law.  HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics.