Senior Director, Care Management
1 month ago
Salary Range: $149, Min.) - $201, Mid.) - $254, Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
The Senior Director, Care Management (CM) is responsible for the setting and carrying out the overarching strategic direction and goals of the Care Management department. This position maintain and oversee proper delivery, coordination and execution of all Care Management related services and activities to L.A. Care members across the organization. This role will oversee and manage a large team of clinical and non-clinical staff while working in cross collaboration with both Senior Medical Directors and other senior departmental leaders. Primary responsibilities will include developing, enhancing and implementing various care management programs, including but not limited to complex care management (CCM), enhanced care management (ECM), transitions of care (TCS), Interdisciplinary Care Plan (ICP) creation, Health Risk Assessment completion and follow up, care coordination and Disease Management while maintaining regulatory compliance and operational efficiency and excellence. The Senior Director will support technological system implementation and/or enhancements as required. This position supports delegation oversight activities, and report on regulatory requirements, including meeting with regulatory agencies as needed.
One of the key initiatives is to increase L.A. Care's community CM presence. The Senior Director, CM is responsible for providing evidence of ongoing compliance with all regulatory and accreditation requirements. This position is 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.
This position is responsible for directing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.
DutiesResponsible 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.
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.
Develops and maintains departmental budgets in line with organizational goals. Assures 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.
Develops goals, objectives and actions plans for assigned staff that includes full management responsibility for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees.
Undertake any additional duties as assigned, demonstrating adaptability and executive-level leadership in addressing evolving organizational needs.
Duties Continued
Education Required
Bachelor's Degree in Nursing or Social WorkIn lieu of degree, equivalent education and/or experience may be considered.Education Preferred
Master's Degree in Nursing or Social WorkExperience
Required:
At least 8 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 6 years of leading staff or supervisory/management experience.
At least 3 years of relevant Health Plan experience.
SkillsRequired:
Excellent verbal, written and presentation skills.
Critical thinking skills.
Ability to think strategically and build continuity between programs.
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 RequiredLicenses/Certifications Preferred
Certified Case Manager (CCM)Registered Nurse (RN) - Active, current and unrestricted California LicenseLicensed Master of Social Worker (LMSW) - Active, current and unrestricted California LicenseRequired Training
Physical Requirements
LightAdditional Information
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
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