Senior Director, Care Management

Sutter Health•Sacramento, CA

3d•$200,096 - $320,154•Hybrid

About The Position

The Senior Director, Care Management leads care management for Sutter Health’s Sacramento and Central Valley Divisions. The role partners with leadership on strategic initiatives, including Total Care Accountability, new product offerings, and partnerships related to healthcare reform. It oversees the planning and execution of care management activities to improve care coordination and transitions across acute, ambulatory, and palliative services. The position develops operational systems and promotes system-wide and division-based best practices in care management, continuity of care, disease management, and clinical outcomes for inpatient and outpatient case management and social services. It collaborates across the organization to identify optimization opportunities, improve efficiencies and communication, and deliver measurable improvements in quality, service, and cost-effective care. This is a hybrid role combining remote work and on-site responsibilities. The employee is expected to reside within Sutter Health’s geographic footprint and travel to hospitals and other care delivery sites in the assigned divisions, as well as leadership meetings in the Bay Area and Central Valley. The role is full-time, weekdays, with a day shift and no weekend requirements.

Requirements

Graduate of an accredited school of nursing.
California Registered Nurse (RN) licensure.
15 years of recent relevant experience.
Expert clinical knowledge of care management principles related to population health, typically acquired through 5–7 years of senior-level clinical management experience.
Comprehensive knowledge of CMS Conditions of Participation related to utilization review and discharge, and other applicable federal and state regulations for case management and social work across the care continuum.
General knowledge of the health benefits business, clinical issues, market trends, medical management and delivery systems, utilization and quality management, contracting, benefits interpretation, provider relations, and government rules affecting healthcare reimbursement.
Working knowledge of state and federal regulations governing immunity for peer review confidentiality.
Thorough knowledge of capitation and its implications for care delivery operations and management, including demonstrated success improving the efficiency and effectiveness of large physician groups in significant capitated markets.
In-depth knowledge of utilization review, case management, managed care, clinical effectiveness, clinical pathways, disease management, recovery audit contractor responses, and quality improvement initiatives.
Working understanding of business planning, including analysis, statistics, budgeting, feasibility studies, and implementation.
Ability to define and implement care management philosophy, goals, objectives, standards, and procedures aligned with organizational strategies.
Leadership, facilitation, organization, prioritization, time management, team building, project management, negotiation, and conflict-resolution skills.
Ability to work across all levels of a large healthcare organization and build value and buy-in for a functional, cost-effective continuum of quality care.
Written and verbal communication skills, including the ability to explain complex medical and business concepts in lay terms to diverse audiences.
Strong analytical and problem-solving skills, including the ability to develop effective solutions, build consensus, and foster collaborative relationships.
Attention to detail and critical-thinking skills for investigating complex issues, analyzing data, interpreting healthcare laws and regulations, and formulating solutions.
Advanced computer competency in Microsoft Office Suite and other relevant research and analysis software.

Nice To Haves

Experience leading acute care management, utilization management, and social services operations within a multi-hospital health system.
Demonstrated success improving care progression, length of stay, patient flow, discharge efficiency, and transitions of care.
Experience developing and implementing standardized workflows, system-wide best practices, and performance-improvement initiatives across multiple facilities.
Experience using data analytics, performance dashboards, and industry benchmarks to improve clinical, operational, and financial outcomes.
Demonstrated ability to collaborate with physician leaders, nursing, finance, managed care, and post-acute care partners to improve coordination and resource utilization.
Knowledge of regulatory and accreditation requirements, utilization management practices, medical necessity criteria, and payer policies.
Experience leading organizational change, developing high-performing teams, and establishing accountability through measurable goals and performance management.
Familiarity with Epic or other electronic health record systems and using technology to improve care management workflows and operational effectiveness.
Experience supporting value-based care initiatives, population health strategies, and partnerships across the continuum of care.
Understanding of and experience with Lean or other process-improvement philosophies and methodologies.

Responsibilities

Lead care management for Sutter Health’s Sacramento and Central Valley Divisions.
Partner with leadership to advance strategic initiatives, including Total Care Accountability, new product offerings, and healthcare reform partnerships.
Oversee planning and execution of care management activities to improve coordination and transitions of care.
Develop systems and day-to-day operations for managing care across acute, ambulatory, and palliative services.
Collaborate across the organization to identify optimization opportunities, business efficiencies, and operational linkages, and to encourage cross-organization communication.
Lead and promote system-wide and division-based best practices in care management, continuity of care, disease management, and clinical outcomes across inpatient and outpatient case management and social services.
Deliver measurable improvements in quality of care, service, and performance efficiencies while supporting cost-effective care.
Develop and implement area-wide care management philosophies, goals, objectives, standards, policies, and procedures aligned with corporate strategies.
Travel to hospitals and other care delivery sites within assigned divisions and attend leadership meetings in the Bay Area and Central Valley.