Executive Director Corporate Care Management

Title: Executive Director, Care Coordination

Location: Fountain Valley, CA

Department: Administration

Status: Full-time

Shift: Days

Pay Range*: 168k - 231k

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 Executive Director of Care Coordination has responsibility and oversight for the system Case Management, and Social Work Service programs within hospital services and MCMF, guiding operational and clinical issues for high quality, cost effective, integrated processes in support of patient care while maximizing the revenue cycle.The incumbent establishes strategic and results oriented tactics, goals and objectives using a collaborative, team approach to deliver excellent patient experience, safety and care progression that is fiscally responsible and meets current and anticipated needs of the community served. The incumbent is responsible for building relationships and creating partnerships with community organizations to build programs and resources.

The Executive Director of Care Coordination ensures systems and processes are in place to support regulatory and accreditation compliance with state and federal regulations as well as related accrediting bodies for all programs within the scope of the assigned departments and services are within the defined span of control.

The Executive Director of Care Coordination is accountable for human and material resource acquisition, quality/performance improvement outcomes to maximize patient throughput, utilization management, authorization and billing process to enhance outcomes, and readmission prevention.This role will assist with Utilization Management Committee key metrics including length of stay, authorization related key performance indicators, referral delays, and care progression. The success of the departments depends significantly on the incumbent’s ability to collaborate with other leaders across the health system to develop and maintain systems that support patient care through care coordination strategies and revenue cycle improvements.

Principal Duties and Responsibilities:Briefly describe the major responsibilities and functions of this position.

• Develop and execute a comprehensive strategy for care coordination, case management, and help coordinate utilization management that aligns with the healthcare system’s mission, vision, and goals.
• Lead and manage a multidisciplinary team of case managers/care coordinators, and social workers ensuring effective team performance and professional development.
• Design, implement, and monitor system and standardized programs to improve patient transitions across the continuum of care, reducing readmissions and enhancing patient outcomes.
• Collaborate with clinical leadership, physicians, and external partners to integrate care management/coordination and utilization management activities and promote best practices.
• Establish and maintain policies, procedures, and standards for care coordination and case management that meet regulatory and accreditation requirements.
• Analyze and utilize data to identify opportunities for improvement, measure program effectiveness, and report outcomes to executive leadership.
• Drive initiatives to enhance patient and family engagement, ensuring culturally competent care and addressing social determinants of health.
• Oversee budget planning and financial management for care coordination services, ensuring cost-effective operations.
• Serve as a subject matter expert and advocate for care coordination and case management within the healthcare system and in the broader community.

Care Management: The Executive Director of Care Coordination reports to the Chief Clinical Transformation Officer . This role will provide system responsibility and comprehensive oversight of Care Management (CM) programs for the hospitals and Medical Foundation services through a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet MemorialCare patient’s needs.The incumbent facilitates this segment of the leadership team by approaching CM through advocacy, communication, and resource management, promoting quality, cost-effective interventions and outcomes.

Social Work Services: The Executive Director of Care Coordination reports to the Chief Clinical Transformation Officer . This role will provide system responsibility and comprehensive understanding of the social work service programs for the hospital and Medical Foundation services through the theory and practice of social work in a health care setting and of the regulatory structures that underlie it, principles of social justice, human rights, and respect for diversities that are central to social work.The incumbent facilitates this segment of the leadership team serving as an executive lead across the system for internal and external social work committees, promoting cost effective care, compliance, and regulatory strategies for clinical and revenue optimizations.

Utilization Management: The Executive Director of Care Coordination reports to the Chief Clinical Transformation Officer This role will work with the Executive Director of Utilization Management to support UM programs for hospital and MCMF services to optimize the financial health of MemorialCare by maximizing high performing UM processes for authorizations, billing compliance and clinical appeals outcomes.

The Executive Director of Care Coordination is responsible for planning and developing new services within the scoped departments, policy formation, human resource management and organization and regulatory compliance. The incumbent develops and implements effective and efficient standards, processes, decision support systems, reporting and benchmarks that support ongoing improvements of clinical operation functions and promotes quality cost -effective health care. In addition to overseeing Care Coordination internal operations, the incumbent works closely with Managed Care, Patient Access, Nursing Services, Patient Financial Services, Operations, IS, Quality, Compliance, Medical Directors, external partnered vendors and payor teams to ensure MemorialCare patients receive appropriate access to care and coordinated, evidence-based services.

Leads as a professional role model, demonstrating commitment to the organizational values 

An executive lead of the Utilization Management Committee, responsible for partnered oversight of compliance and regulatory maintenance to CMS standards, guiding system reporting and educational standards.

Demonstrates professional leadership practices that facilitates improvement and empowerment of management and staff in critical thinking and decision-making using Lean Management Philosophy, Systems and Tools.

Formulates strategic and results oriented tactics, goals and objectives cascading from the Strategic Plan and executive leadership and MemorialCare system direction.

Establishes collegial and collaborative relationships with the medical staff, nursing and inter-professional leaders.

Attends various designated and associated committee meetings to ensure coordination of efforts.

Participates in campus wide and MemorialCare initiatives as necessary based on role, or as assigned.

Supervises and manages executive directors, directors, managers, and team to coordinate the day to day operation

Directs clinical services and care coordination to ensure a safe environment for delivery of high-quality care. 

Implements and directs continuous improvement of clinical quality to achieve outstanding patient and family experience, safety and timely progression of care.

Plans, controls, and directs all operational processes for high quality functioning of span of control.

Advises appropriate personnel action in consultation with Human Resources, as needed, and promotes a Just Culture.

Directs leaders in appropriate utilization of staffing and scheduling of staff to ensure productivity and safe environment for care delivery at all times.

Ensures leadership accountability for safe, efficient and effective utilization and coordination of staff.

Develops implements and maintains ongoing performance improvement and quality initiatives applying Lean Management Philosophy, Systems and Tools.

Engages medical staff to ensure integration in inter-professional teamwork and collaboration that promotes effective communication for quality and safety.

Implements and directs continuous improvements to meet organizational fiscal requirements.

Formulates strategic and results oriented tactics to address revenue enhancement across all departments and settings.

Engages medical staff and hospitalists to ensure collaboration that promotes appropriate resource utilization, charting and throughput.

Responsible for key metrics including length of stay, readmissions, authorization related financial performance.

Operationalizes reimbursement parameters via coordination with multiple department heads and Care Lines, Medical Staff, and per executive leadership, initiatives and the strategic plan.

Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting and benchmarks that support ongoing improvements of clinical operation functions and promotes quality cost-effective health care.

Utilizes Lean management systems and processes to continually strive toward performance improvement and development of high quality, cost-effective utilization management processes that support patient care while maximizing the revenue cycle.

Ensures areas within span of control meet organizational, regulatory and accreditation requirements. 

Educates leaders and establishes processes to promote compliance and problem solving with clinical leadership and staff.

Ensures ongoing survey readiness.

Ensures oversight of the development of policies and procedures to ensure

effective care delivery system that are created, reviewed and updated on a timely basis.

Ensures utilization management, authorization and billing systems meet highest expectations and organizational fiscal requirements.

Plans and develops new services, policy formation, human resource management and organization and regulatory compliance.

Promotes professional practice and workforce development.

Collaborates with teams to develop and implement standards to maintain professional practice that promotes excellence and is consistent with community standards, legislative changes and current trends.

Keeps abreast of current healthcare trends in order to develop administrative and clinical operational improvements that are evidence-based.

Seeks to establish innovative methods that encourage the retention and recruitment of staff.

Implements staff educational programs to ensure continuity of staffing with staff competent for related patient conditions.

Ensures control for operating budgets within span of control.

Preparation of operating budgets that forecast annual needs and reflect requirements for quality patient care delivery including expected changes related to business/health care/contract or community needs.

Develops monitoring standards to maintain expenditures within budgetary parameters for bi-weekly, monthly and annual targets.

Monitors all aspects of the budget and holds managers accountable for achieving budget targets.

*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.

Minimum Requirements

Qualifications/Work Experience:

 Licensed health care professional with a minimum of 5 years of management experience of case management and/or utilization management in an acute care hospital setting, including clinical operations. 

Education/Licensure/Certification:

Bachelor’s degree required.

Active, unrestricted State Registered Nursing (RN) license in good standing.

Accredited Case Manager Certification (ACM or CCM), Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ) or other healthcare or management certification.