Director, Care Management - Full Time - Day Shift
About The Position
The Director, Care Management directs the care management department’s functions and personnel. The role develops, manages, and oversees the annual department budget; prepares and evaluates monthly, quarterly, and annual reports; monitors and communicates changes in Medicare regulations and documentation issues; and maintains relationships and contractual oversight with key stakeholders and local, state, and federal agencies. The position develops and motivates the care management team, monitors utilization metrics, and oversees accountability for on-site monitoring reviews conducted by outside review organizations and third-party payers. It also supports education and monitoring of utilization patterns across on-site and enterprise-wide stakeholders and performs other job-related duties as assigned. Adventist Health requires associates to receive required vaccinations as a condition of employment and annually thereafter where applicable. Medical and religious exemptions may apply. The organization participates in E-Verify.
Requirements
- Bachelor’s degree or equivalent combination of education and related experience.
- A current, unrestricted California license to practice as a Registered Nurse (RN), Medical Doctor (MD), Doctor of Osteopathic Medicine (DO), or Licensed Clinical Social Worker (LCSW).
Nice To Haves
- Master’s degree.
- Seven years of hospital discharge planning, utilization review, case management, and social work experience.
- Five years of leadership experience.
- Licensed Master Social Worker (LMSW) through a State Board.
Responsibilities
- Direct the functions and personnel of the care management department.
- Develop and motivate the care management team to accomplish department goals and objectives.
- Develop, manage, and oversee the annual care management budget.
- Prepare and evaluate monthly, quarterly, and annual reports of the department’s functions.
- Provide information about changes in Medicare regulations and documentation issues to physicians and others as needed.
- Analyze and monitor utilization metrics and communicate findings as appropriate.
- Oversee accountability for on-site monitoring reviews by outside review organizations and third-party payers.
- Maintain relationships and contractual oversight with key stakeholders, including education and monitoring of utilization patterns.
- Maintain working relationships with local, state, and federal agencies.
- Perform other job-related duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Director
