Director Case Coordination Center

Kaiser Permanente • Downey, CA

409d

About The Position

The CCC Director is responsible for overseeing patient care and managing medical expenses related to complex care across various settings, including emergency and contracted care. The role prioritizes patient safety, regulatory compliance, and quality of care for Kaiser Permanente members. The director will manage one of three services, ensuring efficient operations and coordination of care for members in non-Kaiser facilities, while also leading a team of healthcare professionals and support staff.

Requirements

• Minimum four (4) years of management experience.
• Minimum five (5) years of program development and management experience in medical centers or hospitals.
• Bachelor's degree in a relevant field.
• Experience working with call centers and telephony operations.
• Knowledge of regulatory agency requirements affecting reimbursement and claims management.
• Proficient in computer and software applications.

Nice To Haves

• Minimum two (2) years of utilization management experience preferred.
• Active RN licensure.
• Graduate degree in a health care related field.

Responsibilities

• Guide patient care and manage outside medical expenses associated with complex care.
• Oversee the operational management of one of three services, including Emergency Prospective Review Program, Outside Utilization Resource Services, and Behavioral Health Care.
• Ensure accurate and timely abstraction of information for all CCC operations.
• Direct and review statistical reports for departmental activity and analyze data for compliance.
• Collaborate with supervisors and physician leads to resolve operational issues.
• Advise leadership on programs to reduce costs of self-referred member care outside the Kaiser system.
• Identify opportunities for operational enhancements and develop proposals for improvement.
• Evaluate and manage staff, including recruitment, hiring, and performance management.
• Coordinate activities to control out-of-plan emergency medical costs while ensuring quality care.
• Ensure compliance with KP benefits and regulatory agencies regarding medical care and reimbursement.

Benefits

• Health insurance coverage
• Dental insurance coverage
• Vision insurance coverage
• 401k retirement savings plan
• Paid holidays
• Paid time off (PTO)
• Flexible scheduling options

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree
• Number of Employees: 501-1,000 employees