This position will remain open until a successful candidate has been identified.
The Director, Care Management is responsible for strategic planning, development and implementation of site-specific Care Management activities, consistent with organizational priorities, monitoring key performance indicators, measuring results, allocating resources and building strategic partnerships to improve care management and transitions of care.
The Director is also responsible for leading best practice work within the hospital as it relates to Care Management healthcare resources, continuity of care and clinical outcomes of all Care Management and social services in the inpatient and Emergency Department settings including; referrals and authorizations, utilization review, discharge planning and social work.
Additionally, the Director promotes solutions that accelerate the dissemination of successful best practices in care management within the hospital, promoting patient centered care and creating organizational alignment around care management. Deliverables result in measurable improvements in quality, service and efficiency across the organization for the benefit of patients, caregivers and customers.
The Director, Care Management is a leader in the organization's pursuit to transform healthcare to achieve the highest levels of quality, access and affordability. The incumbent plays a critical key role in strategic initiatives as well as the pursuit of new product offerings and partnerships e.g. healthcare reform-related opportunities.
A Bachelor's Degree in Nursing.
At least five to seven (5 - 7) years of progressive leadership in care management/utilization management programs with ability to develop and implement efficient and effective programs and operate at a senior administrative capacity within hospitals, physician groups and/or health plan.
Recent professional experience with two (2)+ years working in a tertiary care hospital.
Comprehensive knowledge of CMS Conditions of Participation related to utilization review and discharge and other federal and state regulations related to Care Management, Social Work, etc., across the care continuum.
Knowledge regarding the healthcare market and government rules and regulations impacting health care reimbursement.
Demonstrated results in planning, including analysis, statistics, budgeting and implementation.
Demonstrated exceptional oral and written communication skills.
Ability to work effectively with others as a team member, as well as gain cooperation and support through effective use of influence and persuasion.
Strong leadership skills. Able to set clear expectations for others, implement and execute system-wide Care Management operations.
Able to maintain an organized approach, clarity of purpose, and goal orientation in a rapidly changing environment involving multiple stakeholders throughout the organization.
Results driven and able to drive quantifiable results throughout the organization. Proven skill set in solving complex problems, negotiating and developing actionable recommendations.
Able to manage multiple priorities simultaneously and meet tight or conflicting deadlines.
- A Master's Degree in related field.
- Knowledge of the UC San Diego Health organization is desirable.
- Executive level leadership over multiple sites and levels of care highly preferred.
- Professional experience in an academic health system setting.
- Working knowledge of Miliman Care Guidelines.
Must be able to work various hours & locations based on business needs.