Director, Care Management - 137694

UC San Diego Health is the region's only academic health system and a nationally ranked leader in patient care, research, and education. Our network includes three major hospitals as well as specialty centers, offering advanced services in cardiovascular, cancer, transplant, and maternity care. Recognized by Vizient as a top 10 academic health system for seven consecutive years, and ranked #1 in San Diego and #5 in California by U.S. News & World Report, we consistently earn national honors across multiple specialties. We are proud to hold Magnet designation for nursing excellence since 2011, reflecting our commitment to the highest standards of patient care and professional practice. Join us and be part of an innovative, collaborative environment where your work makes a meaningful impact.

The Director, Care Management is an experienced senior leader and subject matter expert in utilization review, discharge planning and acute care case management/care management department leadership. The Director ensures adequate staffing, directs department resources, plans and implements new or improved operational work flows and/or services in collaboration with Executive Leadership. Frequently collaborates across the health system and with other departments, post-acute care organizations, and payors to achieve desired outcomes.

Oversees through subordinate managers a large department or multiple smaller units, OR manages a highly specialized technical function/team. Has significant responsibility to achieve broadly stated goals through subordinate managers. Determines objectives, directs programs, develops strategies and policies, manages human, financial, and physical resources, and functions with a high degree of autonomy. Proactively assesses risk to establish systems and procedures to protect organizational assets. Determines strategies for a program with organization-wide impact.

Involves the collaborative process among clinicians (typically social services, discharge planning, utilization review, patient throughput), that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the patient's complex medical discharge planning and transitions of care needs, as well as the health and human service needs. It is characterized by planning, advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes.

Key Responsibilities:

* Participates in the strategic planning of care coordination programs, workflows, policies and procedures across the medical center and/or health system.

* Oversees and directs the development of systems to support integrated, effective and efficient work processes.

* Collaborates with Information Technology senior management to integrate care coordination and case management needs in organization-wide IT initiatives, including electronic medical records, revenue management, patient finance, and business intelligence.

* Oversees data analysis and the preparation of presentations, proposals and executive summaries. Utilizes data and metrics to prioritize quality initiatives and long and short term strategic planning.

* Collaborates with patient care directors, service line directors, physician and executive leadership across the medical center or health system, to improve coordination and facilitate optimal patient care throughput. Approves and oversees the implementation of quality improvement measures and plans.

* Advises and consults with physician and executive leadership on integrating case management into patient care delivery models.

* Provides strategic direction to assist in ensuring compliance with accreditation and licensure requirements with the clinical services environment, including JCAHO, CMS, and State of California.

* Responsible for employee performance reviews, recruitment, retention, terminations, and staff development and training programs. Instills strong management practices to create a culture of teamwork, collaboration, and timely achievement of objectives and goals.

* Reviews, approves, and oversees the implementation of best practice methods and policies which improve both patient quality of care and the financial outcomes for the medical center.

• Bachelor's degree in nursing.

• Registered Nurse (RN) issued by the state of California.

• Eight or more years of relevant experience, including five or more years of care management experience in an acute hospital setting.

• Five or more years of manager or higher level leadership experience.

• Certification in Case Management is required within 6 months of hire.

• Strong hospital management skills, with expertise in case management, utilization review, discharge planning, home care and/or managed care.

• Excellent leadership and fiscal management skills, with the ability to create a goal-oriented climate of teamwork, collaboration and consistent achievement of objectives

• Strong knowledge of relevant regulatory requirements, as well as related legislative, accreditation, licensing, and compliance environments.

• Strong competency in financial aspects of healthcare management, blended with an understanding of the ethical, medical, and quality of care issues of case management.

• Advanced communication, interpersonal, and conflict-resolution skills for dealing with patients, families, advocates, other medical and administrative personnel, subordinate staff, and personnel from outside agencies.

• Excellent abilities in critical thinking and problem-solving. Able to assess and evaluate department operations, produce and interpret reports, develop new policies, procedures, strategies, and implementation plans to improve all aspects of case management department function.

• Advanced degree in nursing, health administration or related field strongly preferred.

• Eight or more years of progressive leadership in Care Management is strongly preferred.

• Lean Six Sigma certification and experience leading Lean initiatives.

• Strong Data Analytics experience within a large, complex health system.

• Academic Medical Center experience.

• Must be able to work various hours and locations based on business needs.

• Employment is subject to a criminal background check and pre-employment physical.

• Mandated Child Abuse Reporter (CANRA)