Nursing Director

HUMBOLDT-DEL NORTE INDEPENDENT PRACTICE ASSOCIATION•Eureka, CA

5d•$60 - $78•Onsite

About The Position

The Nursing Director provides nursing leadership, program development, supervision, care coordination strategy, clinical protocol oversight, and quality improvement support across Humboldt IPA/PCC programs. The position is responsible for ensuring that complex and high-risk members receive coordinated, person-centered care across outpatient, inpatient, emergency department, and community settings. The role integrates Priority Care intensive care coordination, utilization management, population health measures, hospital rounding, emergency department follow-up, nursing protocols, and shared clinical leadership for the primary care team.

Requirements

Bachelor of Science in Nursing required; RN-BSN level position.
Current, unrestricted Registered Nurse license in the State of California.
Minimum three years of nursing experience, including experience in ambulatory care, case management, care coordination, utilization management, population health, or transitions of care.
Minimum three years of supervisory, clinical leadership, program management, or administrative health care experience preferred for director-level responsibilities.
Demonstrated ability to apply the nursing process and case management principles to a variety of patients, members, and care settings.
Working knowledge of health care administration-related regulations and how they apply to IPA, utilization management, primary care, and care coordination operations.
Ability to interpret and use data for evaluation, planning, workflow redesign, and performance improvement.
Knowledge of medical office and hospital patient flow, discharge processes, outpatient follow-up, and interdisciplinary communication.
Proficient computer skills, including documentation, word processing, spreadsheets, data entry, reporting, and electronic communication systems.

Nice To Haves

Experience implementing new programs, protocols, quality initiatives, or population health campaigns.
Experience with managed care, value-based care, ACO arrangements, health plan measures, or regulatory reporting.
Experience working with medically complex, high-risk, underserved, older adult, or rural populations.

Responsibilities

Provide nursing leadership, administrative support, and program oversight for Priority Care Center, utilization management, and population health activities.
Supervise, mentor, support, care coordination, utilization management, and clinical team members in collaboration with medical and executive leadership.
Evaluate staffing levels, assignments, workflows, and team roles to improve efficiency, accountability, member outcomes, and department performance.
Develop and maintain reference materials, workflows, tools, and training resources to assist staff in performing their duties consistently.
Identify, evaluate, and coordinate health care services for members and patients with chronic conditions, complex health needs, high utilization, or significant barriers to care.
Apply case management standards of care, including screening, assessment, planning, facilitation, coordination, monitoring, and evaluation.
Establish person-to-person relationships with members while incorporating families, caregivers, providers, clinicians, and support networks into patient-centered action plans when appropriate.
Take a longitudinal view of care needs over weeks, months, and years, with an emphasis on problem solving, health literacy, self-management, and measurable progress toward health goals.
Respond to provider referrals, perform and document nursing assessments, answer general health care questions, explain screening results as appropriate, and coordinate delivery of care across settings.
Provide leadership for utilization management processes, including review of utilization patterns, care appropriateness, resource use, avoidable emergency department use, potentially avoidable admissions, and ambulatory-care-sensitive utilization.
Collaborate with providers, health plans, care teams, and administrative leadership to support appropriate level-of-care decisions, timely care transitions, and care management interventions.
Use best practices, evidence-based guidelines, current research, and regulatory requirements to inform care management, utilization management, and clinical decision support workflows.
Develop and implement action plans when deficiencies, gaps, or opportunities for improvement are identified through utilization or quality review.
Provide back-up for sick and vacation time for UM RNs.
Round locally on hospitalized members and serve as a clinical liaison between inpatient teams, outpatient providers, care coordination staff, utilization management, and the Priority Care Center.
Ensure timely transition planning, discharge follow-up, medication reconciliation follow-up, appointment coordination, and communication of the care plan to the outpatient team.
Work with the team to ensure members seen in the emergency department receive adequate follow-up, outreach, and care coordination after the visit.
Identify recurring inpatient and emergency department utilization patterns and recommend interventions to improve access, continuity, outcomes, and member experience.
Develop, maintain, implement, and monitor RN/MA, and clinic nursing protocols that support safe, standardized, evidence-informed care in clinical settings.
Develop and maintain nursing policies and procedures that conform to current standards of nursing practice, organizational philosophy, operational policies, and applicable state and federal requirements.
Communicate and interpret nursing policies and protocols to clinical staff and monitor implementation, adherence, and opportunities for workflow redesign.
Organize staff training and maintain competency documentation for lab testing, clinic-performed procedures, EKGs, immunizations, chronic disease workflows, care coordination activities, and other patient-related activities requiring training.
Work closely with the Quality Improvement Manager to plan, implement, and monitor disease-specific outreach, quality initiatives, preventive care campaigns, and care gap closure activities.
Develop programs, campaigns, and redesigned workflows to improve population health and utilization measures for health plan members, ACO agreement members, and patients served by PCC locations.
Use population health, quality, and utilization data to identify care gaps, review trends, prioritize outreach, and evaluate the effectiveness of interventions.
Support Triple Aim goals by improving health outcomes, improving patient experience, and reducing avoidable utilization where possible.
Prepare or contribute to reports for Administration, the Board, Quality Medical Administrative Committee (QMAC), Medical Management Committee (MMC), health plan partners, and other regulatory or operational needs as assigned.
Participate in manager meetings, MMC meetings, QMAC meetings, PCC staff meetings, quality improvement meetings, satellite site meetings, department meetings, and other meetings as appropriate.
Conduct regular department or program meetings as assigned, including agenda preparation, follow-up items, and documentation of decisions or action items.
Assist with regulatory, health plan, and internal audits by supporting documentation, policy updates, process monitoring, and corrective action planning.
Coordinate effectively with IPA physicians, PCC providers, clinic staff, hospitals, community agencies, health plans, public health partners, behavioral health providers, and other health care organizations within Humboldt County.
Participate in community and cross-organizational efforts that improve population health and access to coordinated care.
Promote team-based care, role clarity, shared problem solving, respectful communication, and a consistent professional approach across departments and care settings.
Provide direct patient services as needed to support continuity of care, clinical workflows, staffing needs, or urgent member needs.