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Director, Care Management

Job Category:  Clinical
Department:  Care Management
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  8205

             

Job Summary

The Care Management (CM) Director will mainly be responsible for the operational component of the Care Management Department with the main goal of improving key L.A. Care members healthy and access appropriate services. The CM Director will also work with the CM Medical Directors and key staff in designing, enhancing and implementing programs, plan strategically and report on regulatory requirements.   

One of the key initiatives is to increase our community CM presence. The CM Director is also responsible for providing evidence of ongoing compliance with all regulatory and accreditation requirements (i.e. health risk assessments and interdisciplinary care plan and care team programs, population health management. The Director of CM is also responsible for outreaching and working with key stakeholders and provide subject matter expertise in support of the oversight, outreach and training of our Plan Partner Health Plans and Delegated Provider Groups.

Duties

General Essential functions: 
The Director of CM along with the Care Management Medical Director are responsible for the operations, programming and oversight of internal L.A. Care’s Care Management Department, collaboration with internal and external delegates and any operations associated with the Care Management department.  Functions currently include all care management programs (Complex Care Management, Care Coordination and Disease Management).  The CM Director also ensures the CM department performs the following:

 

All contracts [(i.e. Centers for Medicare and Medicaid Service (CMS), California Department of Health Care Services (DHCS)], California Department of Managed Health Care (DMHC) regulations, applicable state and federal regulations, National Committee on Quality Assurance (NCQA) CM Certification, Management Services Agreements & Other Contracts.

 

Oversees and monitors operational compliance with organizational standards, policies and procedures and regulatory requirements.

 

Assures department meets all regulatory time frames on CM.

 

Develops and implements departmental policies and procedures.  

 

Develops and maintains departmental statistical and performance reports.

 

Develops, implements and monitors performance standards.

 

Develops and maintains effective communication mechanisms at various levels of the organization and with external organizations.

 

Develop and maintain departmental budgets in line with organizational goals.  Assure operational effectiveness to meet MCR targets and optimize health care resource utilization.

 

Assures appropriate staff support of Utilization Management and other relevant committees.

 

Supports the maintenance of positive relationships between L.A. Care and external groups

 

Identifies and implements, with approval, programs that improve the provision of services to members.

 

Supports Clinical Assurance/Delegation Oversight in the measurement and analysis of delegated Participating Physician Group (PPG) functions.

 

Internal Health Plan Operational Management: 
Proactively identifies and implements operational modifications to enhance departmental performance.  

 

Develops and implements operational business plans and departmental objectives to support organization strategies and tactics.  

 

Interfaces with and collaborates with other service areas to assure optimal service delivery to members, compliance, and efficiency. Maintain compliance with all internal audits.

 

Human Resource Management: 
Develops and maintains a culturally sensitive work environment that promotes staff growth and education. 

Completes performance appraisals in accordance with established policies and based upon achievement of the L.A. Care mission, value, objectives and management expectations. 

Assures staff have access to appropriate training and educational opportunities.

Oversees development of staff planning, including recruitment and retention.

Education Required

Bachelor's Degree in Nursing

Education Preferred

Master's Degree in Nursing
In lieu of degree, equivalent education and/or experience may be considered.

Experience

Required:
Minimum of 7 years of Care Management experience including progressively responsible leadership experience facilitating quality/process improvement, updating policies/procedures with the latest regulatory and accreditation standards.

 

At least 5-7 years of supervisory/management experience

 

Minimum of 3 years of relevant Health Plan experience.

Skills

Required:
Excellent verbal, written and presentation skills.

 

Critical thinking skills.

 

Ability to efficiently and effectively assimilate information and communicate clearly and promptly to key stakeholders.

 

Ability to analyze and identify trends in reports to facilitate decision for enhancements to program.

 

Proven effective leadership skills.

 

Proficient with MS Office (Word, Excel, Outlook, PowerPoint, etc.)

 

Motivational interviewing skills.

 

Knowledge of compliance standards in the operational function.

Licenses/Certifications Required

Licenses/Certifications Preferred

Licensed Master of Social Worker (LMSW) - Active, current and unrestricted California License
Registered Nurse (RN) - Active, current and unrestricted California License

Required Training

Additional Information

 

Department: Care Management  

Paygrade: N 

 

At L.A. Care, we value our team members’ safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.

As a condition of employment, L.A. Care requires a COVID-19 vaccine. This requirement includes our remote workforce. If you would like to request an exemption, L.A. Care has implemented a process to consider exemptions, for documented medical conditions and sincerely held religious beliefs. L.A. Care will review all exemption requests prior to proceeding with the recruitment process.


Nearest Major Market: Los Angeles

Job Segment: Social Worker, Nursing, Registered Nurse, Medicaid, Medicare, Service, Healthcare

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