The Director, Care Management is responsible for the development and implementation of site-specific Care Management activities that are consistent with organizational priorities, and compliant with accreditation, regulatory and licensure requirements. The Director uses a data driven approach to continuously improve departmental performance leading to high reliability, and to plan and allocate resources. The Director builds strategic partnerships to improve care management and create safe and efficient transitions of care; is responsible for leading best practice work within the hospital as it relates to Care Management, continuity of care and clinical outcomes in the inpatient and Emergency Department settings including utilization management, discharge planning, referrals and authorizations, and social work. The Director promotes solutions that accelerate the dissemination of successful best practices in care management within the hospital, promotes 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 is a leader in the organization's pursuit of high reliability in a culture of safety. The incumbent plays a critical key role in strategic initiatives as well.
Director, Care Management Key Responsibilities:
Participates in the strategic planning and development of care management programs, workflows, policies and procedures across the medical center and/ or health system.
Collaborates with patient care directors, service line directors, physician and executive leadership across the health system to improve coordination and facilitate optimal patient care throughput.
Approves and oversees the implementation of quality improvement measures and plans.
Advises and consults with physician and executive leadership on integrating case management into patient care delivery models.
Provides strategic direction to assist in ensuring compliance with accreditation and licensure requirements with the clinical services environment, including JCAHO, CMS, and State of California.
Responsible for employee performance reviews, recruitment, retention, terminations, and staff development and training programs.
Instills strong management practices to create a culture of teamwork, collaboration, and timely achievement of objectives and goals.
Reviews, approves, and oversees the implementation of best practice methods and policies which improve both patient quality of care and the financial outcomes for the medical center.
Bachelor's degree in nursing.
Eight or more years of relevant experience, with progressive expertise in case management, utilization review, discharge planning, home care and/ or managed care.
Five or more 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 working in a tertiary or quaternary care medical center.
Comprehensive knowledge of CMS Conditions of Participation related to utilization review and discharge planning and other federal and state regulations related to Care • Management, Social Work, etc., across the care continuum.
Knowledgeable regarding the healthcare market and government rules and regulations impacting health care reimbursement.
Demonstrated results in goals setting, planning, including analysis, statistics, budgeting and implementation.
Exceptional verbal and written communication skills.
Strong collaborator with ability to work effectively as a team member as well as gain cooperation and support across other areas of the organization through effective use of influence and persuasion.
Proven manager with effective leadership skills. Able to set clear expectations for others, implement and execute care management operations.
Demonstrates an organized approach, clarity of purpose, and goal orientation in a rapidly changing environment involving multiple stakeholders.
Results oriented; able to drive measurable results throughout the organization.
Proven skill set in solving complex problems, negotiating and developing actionable recommendations.
Thrives on managing multiple priorities successful in meeting tight or conflicting deadlines.
Expertise in use of InterQual.
Advanced degree in related field.
Director-level leadership experience over multiple sites and different levels of care is highly preferred.
Leadership experience in an academic health system.
Must be able to work various hours and locations based on business needs.
Employment is subject to a criminal background check and pre-employment physical.
UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, and several outpatient clinics. UC San Diego Medical Center in Hillcrest is a designated Level I Trauma Center and has the only Burn Center in the county. We invite you to join our dynamic team!
Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.
UC San Diego Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity or sexual orientation. For the complete University of California nondiscrimination and affirmative action policy see: http://www-hr.ucsd.edu/saa/nondiscr.html