Director, Care Management - Multi-Market

Nestled between Burbank and Pasadena, Adventist Health Glendale is one of the area's leading healthcare providers. We are comprised of a 515-bed hospital, two urgent cares, home care services, comprehensive cardiology care and a vast scope of services located in the San Fernando Valley. We are committed to the development and empowerment of our nurses and have received Magnet designation from the American Nurses Credentialing Center. Glendale is known for its urban living, with easy access to dining, entertainment, shopping, amusement parks and outdoor recreation. Adventist Health Glendale is proud to be part of the thriving, diverse community since 1905.

Job Summary:

Oversees function and personnel of the care management department for multiple market areas. Develops, manages, and oversees the annual care management budget. Prepares and evaluates monthly, quarterly, and annual reports of the department's functions for each market. Monitors and reports on changes in Medicare regulations and documentation issues to physicians and others as needed. Maintains relationships and contractual oversight with key stakeholders, local, state, and federal agencies.

Job Requirements:

Education and Work Experience:

• 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

Licenses/Certifications:

• Registered Nurse (RN), Licensed Clinical Social Worker (LCSW) Medical Degree (MD) or (DO) and currently licensed to practice, without restriction, in the State of California: Required
• Licensed Master Social Worker (LMSW) - State Board: Preferred
• Licensed Clinical Social Worker: Preferred
• Registered Nurse (RN) or Medical license MD (MD) or Medical license DO (DO) or Licensed Clinical Social Worker (LCSW): Required

Essential Functions:

• Oversees the care management function at multiple markets. Develops the care management teams 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 for each market.
• 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.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 90 communities on the West Coast and Hawaii with over 400 sites of care, including 26 acute care facilities, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of 37,000 includes employees, physicians and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.