Director of Care Management

Description

JOB SUMMARY

The Director of Care Management is responsible for overseeing the implementation, development, and management of all Care Management programs. This role ensures compliance with all regulatory requirements, establishes efficient processes for patient care management in appropriate programs, and provides leadership to the Care Management team. The Director works collaboratively with clinical and non-clinical staff, physicians, all levels of company leadership, patients, and community resources to deliver quality patient-centered care and achieve optimal outcomes.

Requirements

MINIMUM & PREFERRED QUALIFICATIONS

Education/Training

Minimum: Bachelor's degree in Nursing, Healthcare Administration, Public Health, Social Work, or a closely related healthcare  field.

Preferred: Master's degree (MSN, MHA, MPH, MBA, or MSW) or completion of Vocational Nursing or Registered Nursing program.

Experience 

Minimum: At least five years of progressive experience in care management, population health, or clinical operations, with at least three years in a leadership or management role.

Preferred: At least ten years of managed care experience. Experience in delegated managed care organizations. Experience with NCQA accreditation. Experience managing Medicare Advantage, Medi-Cal, Dual Eligible, or Commercial populations. Experience developing departmental budgets and strategic initiatives.

Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.

Certification(s)

Current unrestricted California RN or LVN license preferred.

Certified Case Manager (CCM), ACM, or other nationally recognized Care Management certification preferred.

Skills, Knowledge & Abilities

· Strong leadership, organizational, and communication skills.

· Ability to collaborate with interdisciplinary teams and manage cross-functional relationships.

· Foster a positive work environment that promotes teamwork, professionalism, and continuous improvement to meet the organizational goals and expectations.

· Communicate effectively with leadership, team members, and external contacts.

· Ability to work effectively with others, delegate responsibilities, and independently manage tasks while meeting established deadlines.

· Problem-solving and critical thinking skills.

· In depth knowledge of industry best practices and regulatory compliance.

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS

The physical, mental, and environmental demands described here are representative of those required to successfully perform the essential functions of this job. This position requires the ability to remain sitting for extended periods in an office and/or remote environment, along with frequent repetitive motions such as typing, clicking, and handling documents. The role may occasionally require lifting items weighing up to 25 pounds, such as files or office supplies. Successful performance requires sustained attention to detail, strong focus, and the ability to maintain mental concentration over long durations. Work is typically performed in a standard office or clinical administrative environment and may involve regular exposure to confidential health information. Additionally, the position requires the capacity to manage stress associated with deadlines, high-volume workloads, and the fast -paced nature of health information operations.

PAY RANGE

$130,000.00 - $145,000.00 / annually