Senior Director, Care Management

Sutter Health•Sacramento, CA

2d•Hybrid

About The Position

The Senior Director, Care Management plays a critical role in Sutter Health’s efforts to transform healthcare by achieving high levels of quality, access, and affordability. The role partners with leadership on strategic initiatives, including Total Care Accountability, new product offerings, and healthcare reform partnerships. It oversees the planning and execution of care management activities that improve coordination and transitions of care, and develops systems and daily operations to manage care across acute, ambulatory, and palliative services. The position leads system-wide and operating-unit best practices for care management resources, continuity of care, disease management, and clinical outcomes across inpatient and outpatient case management and social services. It works across the organization to identify efficiencies and improve communication, and delivers measurable quality, service, and performance improvements in a cost-effective care environment. The role provides care management leadership for Sutter Health’s Sacramento and Central Valley Divisions. The employee is expected to reside within Sutter Health’s geographic footprint. This is a hybrid role combining remote work with on-site responsibilities. Travel to hospitals and other care delivery sites in the assigned divisions, as well as leadership meetings in the Bay Area and Central Valley, is required.

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 during 5–7 years of senior-level clinical management experience.
Comprehensive knowledge of CMS Conditions of Participation related to utilization review and discharge, and other federal and state regulations related to case management and social work across the care continuum.
General knowledge of the health benefits business, clinical issues, market trends, medical management, healthcare delivery systems, utilization management, quality management, contracting, benefits interpretation, provider relations, and government rules and regulations 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 an area-wide care management philosophy, goals, objectives, standards, and policies and procedures aligned with corporate strategies and goals.
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 accessible terms to diverse audiences.
Strong analytical and problem-solving skills, including the ability to develop solutions and build consensus while fostering 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.
Expected to reside within Sutter Health’s geographic footprint and travel to care delivery sites and leadership meetings as required.

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.
Ability to collaborate with physician leaders, nursing, finance, managed care, and post-acute care partners to improve care 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 driving 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

Partner with leadership on strategic initiatives, including Total Care Accountability, new product offerings, and healthcare reform partnerships.
Oversee the 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 linkages, and to encourage cross-organization communication.
Lead and promote system-wide and operating-unit best practices in care management resources, continuity of care, disease management, and clinical outcomes.
Oversee case management and social services in both inpatient and outpatient settings.
Deliver measurable improvements in quality of care, service offerings, and performance efficiency while supporting a cost-effective healthcare environment.
Provide Care Management leadership for the Sacramento and Central Valley Divisions.