Senior Director, Care Management, San Ramon, CA or Sacramento, CA
Senior Director, Care Management SR 18-179
San Ramon - Bishop Ranch, CA
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At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.
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Hill Physicians has much to offer prospective employees. We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.
The Senior Director for Care Management is responsible for the oversight and management of inpatient and ambulatory care coordination programs for all lines of business (LOB), in all regions. Develops and implements programs that maximize care quality and continuity, improve the patient experience, and increase value through utilization of appropriate resources and coordination of care in the appropriate care setting. Understands and promotes the organization's mission, vision, values, priorities, and financial goals, lending expertise, experience, and leadership to new strategies and interventions designed to produce optimal quality outcomes with efficient use of clinical resources. Collaborates with other PriMed staff in supporting the Hill Physicians Medical Management Program. The Senior Director assesses and evaluates the care/services rendered, staffing levels, competency and educational needs of staff and effectively coordinates and controls resources.
- Collaborate with senior leadership to develop and implement strategic plans, operational goals and objectives, and business initiatives.
- Demonstrate strategic thinking in planning, implementing and evaluating programs tied to future growth of clinical operations. Develop and execute short- and long-term goals for the department consistent with organization goals and objectives.Provide overall direction, design, development, implementation, & monitoring of utilization, case management and Clinical Code Review operations for all regions to meet organization goals.
- Monitor clinical and utilization trend data to identify/develop strategies to improve resource utilization, service delivery, and work flow to meet organization expectations; perform operations analysis with appropriate follow-up interventions.
- Lead department change management efforts in integrating health care delivery systems, such as work restructuring, process redesign, technological innovations, and shifts in the focus of care.
- Develop and implement processes to ensure that care coordination, wellness, prevention, and chronic care management programs are integrated across levels of care and in conjunction with office providers.
- Collaborate with key stakeholders to develop strategies and initiatives related to accountable care (ACO) projects and other innovative programs. Work effectively with internal and external ACO clinical leadership, PPO leadership and administrative leadership, network physicians, nurses and a wide variety of other staff to develop tactical plan expectations and ensure that programmatic goals are met.
- Collaborate with Sr VP Clinical Services, Medical Directors and other organization and health plan leaders to identify strategies to improve facility utilization, efficiency and quality of service delivery and work flows.
- Collaborate with IT and other clinical stakeholders to develop and implement technology solution that improve care efficiency, quality of service and reporting of clinical programs.
- Monitor all high-risk/high-cost/high-utilization patient trend data and develop systematic interventions in regard to appropriate and effective care delivery/setting, referral management, and contracting needs.
- Maximize resource efficiency to carry out care management and clinical code review activities.
- Ensure departmental adherence to Human Resources policies and guidelines. Define expectations for performance and hold subordinates accountable. Ensure appropriate human resources management including hiring, firing, training, annual performance evaluations, and positive discipline.
- Interface with health plan clinical leadership to resolve escalated patient care issues.
- Ensure departmental compliance with all applicable laws, regulatory agency requirements, health plan delegation and accreditation standards, standards of practice, and organizational service, quality and safety standards.
- Active unrestricted California RN license
- Bachelor’s degree in Nursing or related field, or equivalent combination of experience and education
- Minimum 5 years of clinical experience
- Minimum 5 years management experience in a managed care setting
- Case management knowledge and experience in a healthcare setting; including inpatient and/or outpatient utilization management, discharge planning, complex case management
- Understanding of business planning including data analysis, statistics, budgeting
- Leadership, communication, negotiating, time management, priority setting and project management skills
- Demonstrated ability to plan, set and accomplish multiple objectives
- Demonstrated ability to lead change and effectively manage conflict
- Attentiveness to detail, exhibiting self-direction, high degree of independence, judgment and discretion, teaching ability, effective oral and written communication skills, demonstrate ability to work effectively with others as a team member and the leadership skills to develop and execute region-wide inpatient and ambulatory case management and medical review
- Demonstrated ability to create high-performing, interdisciplinary team
- Must demonstrate customer service skills appropriate to the job
- Ability to establish and maintain effective working relationships with internal and external stakeholders at all levels across the health care delivery system
- Excellent written and verbal communication skills in English
- Must demonstrate ability to effectively communicate with staff and senior management
- Demonstrated computer skills in MS Office programs including Word, Excel and Outlook
- Master’s degree in Nursing or related health field
- Case Management Certification
- Utilization Management Certification