Job Description

Montage Health’s application process has changed effective 12/20/2019.
If you submitted an online application prior to 12/20/2019, you will be required to recreate your profile information if you want to apply to any new positions. You will no longer have access to your previously saved profiles and applications. Current employees applying for transfer into a posted position must also create a profile.

  • CHOMP has been voted the Best Place to Work in Monterey County for 10 straight years
  • Excellent Pay and Generous Benefits including a Pension and Continuing Education Reimbursement
  • Excellent Team Oriented Culture
  • Free Gym for Employees

Job Description:

Summary:

The Director of Care Management provides the oversight to ensure the company’s care management and contractual performance objectives are met, programs and resources are used effectively and successful execution of both short and long term population health goals. The Director of Care Management is responsible for leading, developing, and operationalizing care management/care coordination within our population health strategy, education and quality improvement activities for the clinical team. This position assesses individual and group competencies and performance using best practice standards and NCQA Care Management criteria and assists with developing the documentation tools to create impactful standard work.

Responsibilities:

  • Leads and supervises the clinical teams by demonstrating the capacity and expertise to operationalize best practice recommendations, evidence based standards, system goals and regulatory requirements
  • Responsible for coordination of care across the continuum and population health management
  • Establishes a culture of excellence in performance and innovation that optimizes opportunities to create new models and processes that better serve patients and their families, with the goal of reducing medical spend and enhancing quality outcomes
  • Recognize and respond to patient care issues providing direction, feedback, and follow-up to staff and other members of the healthcare team
  • Plans, assign and review the work of staff to ensure that objectives are met
  • Responsible for recruitment and staff oversight, including performance evaluations of clinical staff; oversees the onboarding and orientation of all new care management department new hires including assignment of preceptors, orientation calendar and scheduling of relevant experiences
  • Establishes and monitors metrics and benchmarks to focus the work and drive collective improvements in care
  • Audit patients charts to identify trends in care, proactively identifies issues facing the membership served and gaps in service in the provider network 
  • Works closely with Managed Care team and staff in the ambulatory environment
  • In conjunction with leadership, identifies the tools and systems needed to support care management activities
  • Develops and maintains a comprehensive education and training program for care management team, inclusive of case review and case study
  • Performs individual and group competency assessments of clinical knowledge, workflow knowledge and systems skills and assists with motivating and teaching team to excel; this includes periodic review of employee chart documentation to ensure compliance to best practice and standards
  • Uses the latest and most innovative evidenced-based training strategies as well as clinical knowledge to develop and deliver orientation and training materials in a variety of methods including presentation materials, manuals, support materials, case studies, etc.
  • Works with leadership to continuously evaluate quality and performance to identify issues and propose process improvement strategies
  • Prepare budget for assigned of responsibility and be accountable for adherence to the budget

Competencies:

  • Problem Solving and Decision Making:  Identifies, analyzes, organizes, and solves problems and issues in a timely, effective manner; uses data and input from others to make sound, timely decisions even in the face of uncertainty
  • Integrity:  Consistently honors commitments and takes responsibility for actions and words
  • Flexibility:  Demonstrates adaptability and openness to alternative solutions and flexibility when interacting with others, understanding their attitudes, needs, interests, and perspectives
  • Leadership:  Leads and motivates others, fosters teamwork, encourages critical-thinking, provides clear and consistent direction and provides staff with growth and development strategies. Represents the organization in a manner consistent with short and long term goals, prioritizing relationship building and collaboration.
  • Inclusiveness:  The ability to network and partner with all internal and external stakeholders including broad and diverse representation of private/public and traditional/non-traditional community organizations

Requirements:

  • A minimum of five years of experience as a registered nurse and two years in care/case management leadership role
  • Current CA RN license
  • Bachelor of Science degree, Masters preferred in Nursing, Public Health, or related field or equivalent combination of experience and education
  • Care Management certification, or commitment to achieve within 1 year of employment
  • Ability to analyze and integrate information and make sound decisions based upon established guidelines
  • Commitment to the creation of a collaborative and supportive work environment
  • Thorough understanding of health plan and regulatory rules, managed care, care management, disease management and referral processes
  • Highly self-motivated, organized and detailed oriented with an attitude for continuous improvement
  • Proven success in teambuilding and training/coaching staff to meet operational requirements and goals
  • Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously
  • Highly professional with excellent written and verbal communication skills
  • Proficient with computer software programs, including Microsoft Word, Excel and Electronic Health Records

Preferences:

  • Knowledge of implementing and evolving healthcare information technology systems to support operations, EPIC experience preferred
  • Physician Practice management/operations experience
  • Bilingual

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Assigned Work Hours:

Position Type:

Regular

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

Apply Online