Director of Case Management Job at MemorialCare, Fountain Valley, CA

QjkwcXR3QzgwY1pOc0g2YTl4KzNIVHZ0RkE9PQ==
  • MemorialCare
  • Fountain Valley, CA

Job Description

Description - External

Title: Director of Case Management

Location: Fountain Valley, CA

Department: Medical Foundation

Status: Full-time

Shift: Days

Pay Range*: 147-202K

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 Director of Care Management will establish and implement programs, in adherence with compliance and regulatory requirements, that ensure effective and efficient coordination of patient care. As a key driver of Value Based Care initiatives, this leadership position will balance clinical excellence with financial stewardship, while prioritizing the needs of the patient and caregivers. This position will work closely with all levels of organizational leadership, including Medical Director leadership.

Principle Duties Include:

  1. Create framework to regularly identify and review rising and high-risk patients for timely and proactive interventions and care management strategies
  2. Provides leadership and management of clinical care coordination, discharge planning and outcomes management
  3. Manages the systems, processes and outcomes of clinical case management teams designed to address the clinical and support needs of patients and caregivers
  4. Develop workflows, policies and procedures to ensure and maintain case management delegation contract requirements and all regulatory requirements are met.
  5. Accountability of case management staff, in conjunction with team leaders, including
  6. Department budgetary process within each fiscal year including planning and monthly oversight to potential and real variances. Timely communication to reporting manager and corrective action to ensure future budget alignment.
  7. Set culture of engagement for department and work to increase bench strength and leadership development within teams
  8. Set departmental goals, program planning, and maintain an environment of high clinical excellence, efficiency and continuous improvement
  9. Establish performance measures for clinical care management
  10. Develop collaborative relationships with hospital leadership, physicians and service line leaders to deliver on shared Value Based outcomes
  11. Knowledge of State and Federal regulations including, but not limited to, EMTALA, MediCal, Medicare and HMO’s

*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:

  1. Minimum 5 years of progressive experience in management leadership
  2. Strong managed care and case management background
  3. Exceptional verbal, written and critical thinking skills
  4. Valid RN License in the State of California
  5. Work experience applying evidence-based criteria (i.e.: MCG, lnterqual); Health plan medical policy / clinical coverage guidelines.
  6. Knowledge of CMS (Centers for Medicare and Medicaid Services) coverage policies required.

Education/Licensure/Certification:

  • Valid RN License in the State of California
  • CCM preferred

Job Tags

Full time, Contract work, Work experience placement, Shift work,

Similar Jobs

Securitas Security Services USA, Inc.

Security Officer Job at Securitas Security Services USA, Inc.

**Security Officer**Securitas is a global company that offers the most advanced and sustainable security solutions in the industry....  ...our culture, help define who we are and guide our actions.No experience necessary! If you have retail, food service or hospitality industry... 

TELUS Agriculture & Consumer Goods

Security Consultant Job at TELUS Agriculture & Consumer Goods

 ...friendly team as the innovative technology solutions we offer. We live in and work in a rapidly evolving digital world where cyber security is critical. Protecting information and ensuring the reliability of network and services is paramount. Our team strives to always... 

Global Community Charter School

PreK-8 Special Education Coordinator 25-26 School Year Job at Global Community Charter School

TITLE: PreK-8 Special Populations Coordinator DEPARTMENT: Instructional, 12-month position REPORTS TO: Principal DATE PREPARED/REVISED: January...  ...populations, including students with Individualized Education Programs (IEPs), students who are designated English as a... 

Cooperative Producers Inc

Tire & Oil Technician Job at Cooperative Producers Inc

 ...success of our cooperative. CPI is seeking a dedicated Tire & Oil Technician to join our expanding team. We deeply value our...  ...and preventative maintenance on vehicles and equipment. No experience necessary, training provided. Generous benefits and competitive... 

Get It - Finance

Expat Tax CPA Manager - Remote - WFH - Job at Get It - Finance

About the Role We're looking for an experienced CPA Manager who is ready to lead a team of tax professionals and make an impact in...  ...supportive, exciting environment. - The flexibility of fully remote work. --- If you're ready to take on this exciting challenge...