Director, Care Management (Full-Time, Day Shift)

About the role

Located in a tight-knit community in Kings County, Adventist Health Hanford has been serving the Central Valley since 1965. We are comprised of a 173-bed hospital and many outpatient clinics with primary and specialty care services. Hanford residents are proud of their city's historic charm and family-friendly atmosphere. Within an hour's travel time, Yosemite, Sequoia and Kings Canyon National Parks can be enjoyed.

Responsibilities

• Direct function and personnel of the care management department.
• Develops, manages, and oversees the annual care management budget.
• Prepares and evaluates monthly, quarterly, and annual reports of the department's functions.
• Monitors and reports on changes in Medicare regulations and documentation issues to physicians and others as needed.
• Maintains relationships and contractual oversight with key stakeholders, local, state, and federal agencies.

Requirements

• Education and Work Experience: Bachelor’s Degree or equivalent combination of education/related experience: Required Master's Degree: Preferred Seven years' hospital discharge planning, utilization review, case management and social work experience: Preferred Five years' leadership experience: Preferred
• Licenses/Certifications: Registered Nurse (RN), Medical Degree (MD) or (DO) and currently licensed to practice, without restriction, in the State of California or Licensed Clinical Social Worker (LCSW): Required Licensed Master Social Worker (LMSW) - State Board: Preferred Registered Nurse (RN) or Medical license MD (MD) or Medical license DO (DO) or Licensed Clinical Social Worker (LCSW): Required

Qualifications

• Develops the care management team and motivates them to accomplish department goals and objectives.
• Provides information regarding changes in Medicare regulations and documentation issues to physicians and others as needed.
• Analyzes and monitors utilization metrics and communicates findings as appropriate.
• Oversees accountability for on-site monitoring reviews by outside review organizations and third-party payers.
• Maintains relationships and contractual oversight with key stakeholders, onsite and enterprise-wide, including education and monitoring of utilization patterns.
• Maintains working relationships with local, state, and federal agencies.
• Performs other job-related duties as assigned.

Skills

Not specified

Benefits

Not specified

Pay

The estimated base pay for this position is $153,251 to $229,877. Additional individual compensation may be available for this role through differentials, extra shift incentives, bonuses, etc. Base pay is only a portion of the total rewards package, and a comprehensive benefits program is available for qualifying positions. Please contact our Talent Acquisition team for more information.

Schedule

8 Hours