Director of Care Management, Full time, Days

Under the supervision of the Administrator, Care Management, the Director of Care Management is responsible for the overall administration and direction of the Care Management department, including all day-to-day activities and staffing for utilization review, case management, social work, discharge planning and access/bed control functions. The Director of Care Management acts as a liaison between the clinical and financial components of hospital in support of the provision of appropriate, timely and accurate care management, social work and bed assignment services. The Director represents case management, social work and access services on various hospital committees and shares information between committee and staff members.

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.

Required Skills

• Must have superlative people and results oriented professional management and customer service skills including proven time management, organizational and prioritization skills.
• Must possess excellent verbal and written communication skills and thorough knowledge of processes and details integral to case management, social work, utilization review, discharge planning, clinical documentation improvement and bed control functions. 
• Must have experience in planning and effectively managing departmental budgets and other fiscal responsibilities.
• Must be able to demonstrate ability and skill through prior experience and/or academic expertise in actively leading and managing large-scale change.
• Must have expertise in data management and analysis related to length of stay, case mix, resource utilization, etc. with the intent of identifying opportunities for improvement as well as validating current performance.
• Must have current knowledge of federal and health plan audit programs such as CMS RAC and other related audit activities, value-based purchasing programs, readmission and other related oversight programs resulting in denied reimbursements
• Must have the ability to perform cost-benefit and detailed strategic analysis on data and information sets.
• Must have working knowledge of computer applications such as Excel, Word, and PowerPoint.

Required Experience

Required:

• Active California RN License or Social Work LCSW license
• LCSW or BSN or higher
• Case Manager Certification (CCM) or (Accredited Case Manager (ACM)
• Minimum of five (5) years’ experience in case management, social work, utilization review, and discharge planning in an acute care hospital including at least two (2) years leadership and department management experience.

Preferred:

• Masters in Health Administration or related business field preferred