Senior Director, Care Management RN

Providence • Burbank, CA

285d • $107 - $171

About The Position

As Senior Director of Care Management - Utilization & Appeal Management, you'll collaboratively lead, coordinate, and support care management activities for the South Division. Working alongside the Executive Director, Care Management - South, your leadership will drive strategic vision and operational excellence.

Requirements

• Master's Degree in Nursing, Health Administration, or related discipline.
• California Registered Nurse License.
• 6 years of clinical/operational leadership in complex healthcare environments.
• 5 years at director/manager level in Utilization Management, Appeals Management, or Case Management.
• Ability to develop and implement programs focused on utilization management, appeals management, and clinical case management training.
• Strong interpersonal, analytical, and problem-solving skills.

Responsibilities

• Provide divisional leadership and strategic planning to operationalize standard utilization and appeals management within Providence South Division.
• Develop divisional goals and action plans, implementing program evaluations to ensure success.
• Identify and implement best practices in Utilization Management, Appeals Management, and Post Acute Continuum of Care.
• Sponsor and lead operational excellence initiatives, actively addressing inefficiencies and implementing corrective actions.
• Lead division-wide care management teams, acting as liaison to Regional Business Office and Regional Compliance for denials management.
• Foster positive relationships with managed care organizations to improve communication and reduce denials.
• Maintain adherence to federal, state, and local compliance requirements across the division.
• Facilitate best practices in utilization and appeals management across South Division entities.
• Analyze and report key metrics related to utilization and appeals management, driving continuous improvement.

Benefits

• 401(k) Savings Plan with employer matching.
• Health care benefits (medical, dental, vision).
• Life insurance.
• Disability insurance.
• Paid parental leave.
• Vacation and holiday time off.
• Voluntary benefits.
• Well-being resources.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Hospitals
• Education Level: Master's degree