Located in a tight-knit community in Kings County, Adventist Health Hanford has been serving the Central Valley since 1965. We are comprised of a 173-bed hospital and many outpatient clinics with primary and specialty care services. Hanford residents are proud of their city's historic charm and family-friendly atmosphere. Within an hour's travel time, Yosemite, Sequoia and Kings Canyon National Parks can be enjoyed.

Job Summary:

Direct function and personnel of the care management department. Develops, manages, and oversees the annual care management budget. Prepares and evaluates monthly, quarterly, and annual reports of the department's functions. 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), 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

Essential Functions:

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.

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 as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.

Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.

Director, Care Management (Full-Time, Day Shift)

Key skills

About this role