Director, Care Management - Full Time, Day Shift

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

Essential Functions:

• Develops the care management team and motivates them to accomplish department goals and objectives.
• Develops, manages, and oversees the annual care management budget. Prepares and evaluates monthly, quarterly, and annual reports of the department's functions.
• 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.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.