- Location
- San Diego, CA · 9265 Sky Park Ct. San Diego CA 92123
- Workplace
- Onsite
- Department
- Healthcare
- Seniority
- Manager
- Experience
- 5+ years
Description
Empowering Wellness, Transforming Lives
Optima Medical Management Group is dedicated to enhancing the quality of life by promoting wellness. At Optima MMG and all of its divisions: Serene Health, Community Support, and American TrueCare, our mission is to provide comprehensive support and care that not only addresses immediate concerns but also fosters long-term well-being.
As pioneers in the field, we aspire to lead in member care outcomes and set new standards for excellence and innovation. We are committed to empowering our members to achieve self-sufficiency in health, creating a ripple effect that strengthens families and communities.
Our work culture at Optima MMG is built on pride, passion, and a collective commitment to making a positive difference in people's lives. Our team members are dedicated problem-solvers who bring their unique skills and perspectives to the table. We believe that by fostering a collaborative and supportive environment, we can unlock the full potential of our team and, in turn, provide the best possible care to our members.
A career at Optima MMG is an opportunity to be part of a dynamic and forward-thinking organization. We encourage continuous learning and professional growth, providing our employees with access to industry experts, cutting-edge technologies, and a supportive community that values each individual's contributions. Join us on this journey to not only advance your career but to be a driving force in transforming lives and communities through passionate and fulfilling work!
Job Summary
The Clinical Manager, RN provides clinical and operational leadership for the Enhanced Care Management (ECM) program from our San Diego office. This is a non-bedside, on-site leadership role. The Clinical Manager serves as the clinical authority for ECM care planning and oversees the day-to-day performance of the clinical and care management teams, ensuring medical appropriateness, risk identification, regulatory compliance, and high-quality member outcomes. The Clinical Manager supervises RN Clinical Case Managers and the Mas and provides clinical direction to ECM Lead Care Managers responsible for care coordination and member engagement. The Clinical Manager RN will be responsible for ensuring workflows are maintained and completed in a timely and accurate manner, utilizing task assignment and delegation effectively.
Core Responsibilities
Leadership & Team Management
- Supervise, mentor, and evaluate RN Clinical Case Managers and provide clinical direction to ECM Lead Care Managers.
- Manage staffing, scheduling, caseload assignments, and workflow distribution to meet program and productivity targets.
- Support recruitment, onboarding, and ongoing training of clinical and care management staff.
- Conduct performance reviews, coaching, and corrective action in partnership with Human Resources.
- Foster a collaborative, accountable, and member-centered team culture.
Clinical Oversight
- Serve as the senior clinical resource for escalations, complex cases, and clinical decision-making.
- Oversee clinical department data, workflows and employee metrics, and report those to leadership as required.
- Review and clinically approve individualized ECM care plans; ensure plans are updated with changes in clinical status or utilization.
- Identify and monitor clinical and utilization risks impacting member outcomes.
- Oversee medication review processes for safety concerns, adherence issues, and escalation needs.
- Collaborate with primary care providers, behavioral health clinicians, and internal care teams.
- Oversee clinical staff, approve time cards and time requests.
- Provide feedback, evaluations, and progressive discipline as necessary to promote a fully functioning clinical team.
- Oversee transitions of care following emergency department visits, hospitalizations, or other significant events.
- Oversee the clinical triage chat line, answer and document member interactions from that workflow as necessary.
- Oversee the New enrollment call line and workflow, ensuring timeliness, accuracy and clinical integrity of ICP creation and data entry.
Compliance & Quality
- Ensure care plans and clinical documentation meet Medi-Cal, CalAIM, and ECM program requirements.
- Lead and support audits, chart reviews, and quality improvement initiatives.
- Develop and refine clinical workflows, policies, tools, and best practices.
- Provide clinical education and consultation to ECM staff.
- Ensure timely, accurate, and compliant clinical documentation across the team.
- Oversee internal reporting on member outcomes, utilization, care plan progress, and team performance.
- Performs other duties as assigned.
Required Qualifications
- Active, unrestricted California RN license.
- Bachelor s in science of nursing; MSN preferred.
- Minimum 5 years of clinical nursing experience, including at least 2 years in a supervisory or management role.
- Experience working with Medi-Cal and/or managed care populations.
- Strong clinical judgment, leadership, and communication skills.
- Ability to work independently and collaboratively.
- Ability to work on-site at our San Diego office.
Preferred Qualifications
- Bilingual English/Spanish.
- Case management or utilization management experience.
- Familiarity with Enhanced Care Management (ECM) or Health Home programs.
- Experience leading audits or regulatory reviews.
- Training in Motivational Interviewing or trauma-informed care.
Physical Requirements
- Prolonged periods of computer-based work.
- Ability to lift 10 pounds.
- Flexibility to support program operations.
Benefits
Our full-time employees are eligible for the following benefits enrollment after 60 days of employment:
Medical, Dental, & Vision Benefits: We have various insurance options for you and your family.
Short & Long-Term Disability Benefits: Protection when you need it most.
Voluntary Accident, Voluntary Critical Illness, and Voluntary Hospital Indemnity Plans: Added security for you and your loved ones.
Flexible Spending Accounts: Manage your finances with flexibility.
Employee Assistance Program (EAP): Support when life throws challenges your way.
401(K): Building your financial future with us. Effective after 1 year of employment.
Paid Vacation and Sick Leave: Flexibility for the planned and unplanned.
Paid Holidays: Quality time to enjoy celebrations.
Employee Referral Program: Share the opportunities and reap the rewards.
Company Discount Program: Enjoy savings on everyday expenses and memberships.
Equal Employment Opportunity
Optima Medical Management Group and its divisions are an Equal Opportunity Employer. Optima MMG is committed to providing employment opportunities for all qualified candidates without discrimination on the basis of race, religion, sex, sexual orientation, gender identity, age, national origin, citizenship, disability, marital status, veteran status, or any other characteristic protected by federal, state or local laws. Optima MMG is committed to providing reasonable accommodation for individuals with disabilities.
Pre-Employment
Optima Medical Management Group is a drug-free workplace. Employment is contingent upon a successful pre-employment drug screening and background check.
