Director Care Management

Director Care Management — Remote, must reside in California

Bring your passion for improving the delivery of patient care.

Our client, a progressive, successful managed care organization is looking for an innovative, energetic Care Management/Utilization Management professional. The Director will ensure compliance with regulatory and health plan requirements including DMHC, DHCS, CMS, and NCQA.

This highly visible position will collaborate with Vice Presidents to fully integrate Care Management regulatory and accreditation requirements into delegation oversight monitoring activities.

Join a high-performing team with members who support one another and strive to maintain a work-life balance.

Responsibilities include:

• Leads Accreditation, Audit, and Survey readiness for NCQA, DMHC, and DHCS
• Provides guidance and expertise to Care Management leaders
• Facilitates successful Care Management health plan audits
• Manages Corrective Action Plans, responses, and closures
• Develops and implements strategies to assure ongoing compliance with DMHC and NCQA Care Management requirements
• Reviews and updates training programs, policies, and procedures for Care Management functions
• Develops Delegation Oversight tools, work plans, and program evaluations
• Collaborates with Director of Analytics to develop reports and monitor performance
• Provides project management expertise and oversight
• Establishes a positive relationship with both internal and external stakeholders

Qualifications:

• Graduate from an accredited school for Nursing
• Bachelor's degree, Master's degree preferred
• Active and unrestricted California Registered Nursing license
• Case Manager Certification, CCM preferred
• Minimum 5 years leadership experience at the Director or Manager level
• Minimum 5 years Care Management/Utilization Management experience in a health plan or medical group setting
• 5-7 years of clinical experience preferred
• Subject matter expert in DMHC, DHCS, CMS and NCQA requirements
• Proficient in MS Office programs
• Strong analytical and creative problem-solving skills
• Collaborative style with the ability to develop positive working relationships throughout the organization

Compensation: 170-200K, base salary will vary and be dependent on relevant skills, qualifications, licensure, and experience.

Comprehensive Benefits Include: Medical, dental, pharmacy, vision insurance, and life insurance. Flexible spending account (FSA), Behavioral Health Services, Employee Assistance Program (EAP), 401-K, Income Protection Insurance, Tuition Reimbursement, CEU and License Renewal Reimbursement, PTO, Paid Holidays.

Employer will consider for employment, qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.