Care Management Director: Lead Strategy & Utilization

Adventist Health; Hanford (CA); On-site; USD 153,251 - 229,877; Full time

Job summary

Adventist Health Hanford is seeking a Director to direct the care management function, manage the department budget, and oversee reporting and regulatory updates. The role requires leading a team and coordinating with physicians, payers, and agencies to meet department goals.

The position emphasizes Medicare regulatory knowledge, utilization monitoring, and strong relationships with stakeholders across local and state levels. Experience in hospital discharge planning and leadership is preferred.

Qualifications

• Bachelor’s Degree or equivalent combination of education/related experience: Required.
• Master's Degree: Preferred.
• Seven years' hospital discharge planning, utilization review, case management and social work experience: Preferred.
• Five years' leadership experience: Preferred.
• Registered Nurse (RN), Medical Degree (MD) or (DO) and currently licensed to practice, without restriction, in the State of California or Licensed Clinical Social Worker (LCSW): Required.
• Licensed Master Social Worker (LMSW) - State Board: Preferred
• Registered Nurse (RN) or Medical license MD (MD) or Medical license DO (DO) or Licensed Clinical Social Worker (LCSW): Required

Responsibilities

• Develops the care management team and motivates them to accomplish department goals and objectives.
• Develops, manages, and oversees the annual care management budget. Prepares and evaluates monthly, quarterly, and annual reports of the department's functions.
• Provides information regarding changes in Medicare regulations and documentation issues to physicians and others as needed. Analyzes and monitors utilization metrics and communicates findings as appropriate.
• Oversees accountability for on-site monitoring reviews by outside review organizations and third-party payers.
• Maintains relationships and contractual oversight with key stakeholders, onsite and enterprise-wide, including education and monitoring of utilization patterns. Maintains working relationships with local, state, and federal agencies.
• Performs other job-related duties as assigned.

Skills

Leadership experience

Budget management

Care management

Regulatory awareness

Interdepartmental collaboration

Education

Bachelor’s Degree or equivalent combination of education/related experience

Master's Degree: Preferred

CA RN/MD/DO or LCSW license: Required

LMSW - State Board: Preferred

Job description

Adventist Health Hanford is seeking a Director to direct the care management function, manage the department budget, and oversee reporting and regulatory updates. The role requires leading a team and coordinating with physicians, payers, and agencies to meet department goals.

The position emphasizes Medicare regulatory knowledge, utilization monitoring, and strong relationships with stakeholders across local and state levels. Experience in hospital discharge planning and leadership is preferred.