Director, Case Management Services

Description - External

Title: Director, Case Management

Location: Fountain Valley, CA

Department: Medical Foundation

Status: Full-time

Shift: Days

Pay Range*: 147 -202k

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups – consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.

Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.

Position Summary

The Director of Care Management will establish and implement programs, in adherence with compliance and regulatory requirements, that ensure effective and efficient coordination of patient care. As a key driver of Value Based Care initiatives, this leadership position will balance clinical excellence with financial stewardship, while prioritizing the needs of the patient and caregivers. This position will work closely with all levels of organizational leadership, including Medical Director leadership.

Principle Duties Include:

1. Create framework to regularly identify and review rising and high-risk patients for timely and proactive interventions and care management strategies
2. Provides leadership and management of clinical care coordination, discharge planning and outcomes management
3. Manages the systems, processes and outcomes of clinical case management teams designed to address the clinical and support needs of patients and caregivers  
4. Develop workflows, policies and procedures to ensure and maintain case management delegation contract requirements and all regulatory requirements are met.
5. Accountability of case management staff, in conjunction with team leaders, including
1. Department budgetary process within each fiscal year including planning and monthly oversight to potential and real variances. Timely communication to reporting manager and corrective action to ensure future budget alignment.
2. Set culture of engagement for department and work to increase bench strength and leadership development within teams   
3. Set departmental goals, program planning, and maintain an environment of high clinical excellence, efficiency and continuous improvement
4. Establish performance measures for clinical care management
6. Develop collaborative relationships with hospital leadership, physicians and service line leaders to deliver on shared Value Based outcomes
7. Knowledge of State and Federal regulations including, but not limited to, EMTALA, MediCal, Medicare and HMO’s

*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more... Check out our MemorialCare Benefits for more information about our Benefits and Rewards.

Qualifications - External

Minimum Requirements

Qualifications/Work Experience:

1. Minimum 5 years of progressive experience in management leadership
2. Strong managed care and case management background
3. Exceptional verbal, written and critical thinking skills
4. Valid RN License in the State of California   

1. Work experience applying evidence-based criteria (i.e.: MCG, lnterqual); Health plan medical policy / clinical coverage guidelines.
2. Knowledge of CMS (Centers for Medicare and Medicaid Services) coverage policies required.

Education/Licensure/Certification:

·         Valid RN License in the State of California   

·         CCM preferred