📁
Clinical Support
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Corporate
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20069 Requisition #

Adventist Health is more than an award-winning health system. We provide whole-person care to our communities and champion the greater good - from the operating room to the boardroom, we are driven by our unique passion to live God's love through health, wholeness and hope. From Oregon to Oahu, we have a calling to always do more. Now is your chance to apply your passion to our mission.

 

We're looking for someone to join our team as a Director, Care Management who:

Direct function and personnel of the care management department. Develops, manages, and oversees the annual care management budget. Prepares and evaluates monthly, quarterly, and annual reports of the department's functions. Monitors and reports on changes in Medicare regulations and documentation issues to physicians and others as needed. Maintains relationships and contractual oversight with key stakeholders, local, state, and federal agencies.

 

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.

 

You'll be successful with the following qualifications:

 

Education: 

  • Bachelor's Degree or equivalent combination of education/related experience: Required
  • Master's Degree: Preferred

 

Work Experience: 

  • Seven years hospital discharge planning, utilization review, case management and social work experience: Preferred
  • Five years leadership experience: Preferred

 

Required Licenses/Certifications: 

  • Registered Nurse (RN), Medical Degree (MD) or (DO) and currently licensed to practice, without restriction, in the State of California: Required
  • Licensed Master Social Worker (LMSW) - State Board: Preferred
  • Licensed Clinical Social Worker: Preferred

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