Director Care Management

Providence•Napa, CA

1d•Onsite

About The Position

The Director, Care Management oversees all care-management functions of Queen of the Valley Medical Center and is accountable for daily operations, personnel leadership, fiscal management, and continuous improvement across the Case Management and Social Services departments. This role provides strategic direction and operational leadership for care-management processes including resource utilization review, care management across the continuum, denial management, discharge planning, and length-of-stay (LOS) management, as outlined in the Medical Center Utilization Plan. The Director collaborates closely with physicians, executive leadership, and interdisciplinary teams to review, analyze, and recommend best-practice changes that advance Queen of the Valley Medical Center’s strategic goals. All responsibilities are carried out in accordance with Joint Commission standards, state and federal regulatory requirements, and professional practice standards, with minimal supervision.

Requirements

Bachelor’s Degree in Nursing or Health Services Administration
Licensed Clinical Social Worker (LCSW) OR Licensed Registered Nurse (RN) required upon hire.
5+ years of Case Management experience in an acute-care setting.
3+ years of leadership experience in an acute-care environment.
Advanced knowledge of care-management, utilization review, and discharge-planning practices.
Strong interpersonal, verbal, and written communication skills to: Resolve conflict, Facilitate collaboration and team building, Mentor staff for high performance, Translate complex concepts across varied audiences
Ability to function effectively in unpredictable, high-acuity, and crisis situations.
Proactive problem-solver who addresses system-level outcome issues.
Proficiency with Microsoft Office tools, databases, spreadsheets, and reporting systems.
Knowledge of regulatory requirements and organizational development principles.
Flexibility and adaptability in a healthcare organization undergoing change.

Nice To Haves

Master’s Degree in Nursing, Social Work, or Health Services Administration (preferred)
Association of Case Management certification (preferred upon hire)

Responsibilities

Provide strategic vision and leadership for Case Management and Social Services, including utilization review, discharge planning, case management, clinical documentation management, social services, regulatory compliance, performance improvement, and medical-staff relations.
Direct and integrate prospective, concurrent, and retrospective utilization management across the patient hospitalization.
Collaborate with Community Outreach and Care Network programs to maintain continuity of care across the continuum.
Lead department-specific and hospital-wide performance-improvement initiatives focused on LOS optimization, utilization, documentation compliance, and patient outcomes.
Assess and resolve complex clinical and discharge-planning issues in collaboration with patients, families, physicians, staff, and community partners.
Participate in multidisciplinary rounds and care conferences to remove barriers and improve patient flow.
Oversee recruitment, staffing, orientation, education, and ongoing professional development of Case Management and Social Work staff.
Manage staffing and scheduling, performance evaluations, and human-resources matters including progressive discipline when required.
Create a collaborative, mission-aligned work environment that supports Sacred Encounters, engagement, recruitment, and retention.
Promote interdisciplinary collaboration with physicians, community partners, and internal stakeholders to optimize care coordination.
Maintain and strengthen long-term relationships with post-acute providers, including long-term care facilities, hospitals, hospices, behavioral health agencies, and community organizations.
Educate medical staff and caregivers on care-management philosophy, best practices, and resource utilization principles.
Demonstrate accountability for department budgets, productivity targets, and fiscal performance.
Advocate for resources and technology required to support care-management objectives.
Develop, monitor, and justify operational and capital budget requests.
Prepare and present reports, analyses, and materials related to Case Management and Social Services.
Co-chair and/or facilitate the Medical Staff Utilization Management Committee, ensuring timely fiscal, utilization, and quality reporting.
Serve on hospital and external committees as assigned.
Support and promote community education initiatives and outreach activities.
Participate in self-appraisal, peer review, and performance-review processes.
Evaluate and implement performance-improvement initiatives that support “perfect care” across patient-care programs.
Maintain professional competence and pursue continued growth and development.