Director of Clinical Case Management (RN)

We are partnered with one of the largest non-profit healthcare delivery systems in Orange County searching for a Director to oversee complex case management and ambulatory clinical operationsfor their ACO / Medicare population.

The ideal candidate will be a Registered Nurse with a strong managed care background and an in-depth understanding of ACO and Medicare guidelines.

This company really takes care of both it's patients and it's employees. They constantly give back to the community, and they offer a generous amount of PTO, 401k matching, and great Medical/Dental/Vision plans to every full-time employee.

Salary: $150,000 - $160,000 a year

Schedule: Mon-Fri 8am-5pm (on-site)

Job Duties:

• Oversees the clinical operations of the care management team, including hiring and developing Clinical Management, Nurse Case Managers, and Social Workers
• Ensures cost effective and quality transition of care through the utilization of appropriate resources.
• Designs and Implements performance improvement initiatives within scope.
• Coordinates activity with post-acute and ambulatory care transition teams to create a patient-centric process, in alignment with system hospitals.
• Develops strong relationships with physicians, physician leaders and other providers regarding the flow of patient care within the system.
• Collaborates assesses and makes recommendations to leadership to identify opportunities for improvement in patient care management and optimal process and resource utilization.
• Works with key stakeholders to determine metrics for success.
• Provides information and analysis of performance measurement - identifies better practices to scale within the system.
• Develops and deploys team-based care paths that extend and complement the network physician providers.

Requirements:

• 3+ years' experience in a nursing leadership position
• 3+ years of related managed care experience (Case Manager, Care Manager, Case Management, Care Management, Utilization Review, Utilization Management, Care Coordination, etc.)
• 1+ year working with a Medicare or ACO population
• Licensed Registered Nurse (RN) in CA
• Bachelors Degree or higher education is preferred but not required

Salary range is an estimate.

Job Type: Full-time

Experience:

• ACO: 1 year
• Case Management: 1 year

Education:

• Bachelor's

License:

• RN

• 3+ years' experience in a nursing leadership position
• 3+ years of related managed care experience (Case Manager, Care Manager, Case Management, Care Management, Utilization Review, Utilization Management, Care Coordination, etc.)
• 1+ year working with a Medicare or ACO population
• Licensed Registered Nurse (RN) in CA
• Bachelors Degree or higher education is preferred but not required

All your information will be kept confidential according to EEO guidelines.