Job Abstract

The Senior Director, Care Management (CM) is responsible for the setting and carrying out the overarching strategic direction and goals of the Care Management department.  This position maintain and oversee proper delivery, coordination and execution of all Care Management related services and activities to L.A. Care members across the organization. This role will oversee and manage a large team of clinical and non-clinical staff while working in cross collaboration with both Senior Medical Directors and other senior departmental leaders.  Primary responsibilities will include developing, enhancing and implementing various care management programs, including but not limited to complex care management (CCM), enhanced care management (ECM), transitions of care (TCS), Interdisciplinary Care Plan (ICP) creation, Health Risk Assessment completion and follow up, care coordination and Disease Management while maintaining regulatory compliance and operational efficiency and excellence.  The Senior Director will support technological system implementation and/or enhancements as required.  This position supports delegation oversight activities, and report on regulatory requirements, including meeting with regulatory agencies as needed.  

One of the key initiatives is to increase L.A. Care's community CM presence. The Senior Director, CM is responsible for providing evidence of ongoing compliance with all regulatory and accreditation requirements.  This position is responsible for outreaching and working with key stakeholders and provide subject matter expertise in support of the oversight, outreach and training of our Plan Partner Health Plans and Delegated Provider Groups.

This position is responsible for directing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.

Responsible for the operations, programming and oversight of internal L.A. Care’s Care Management Department, collaboration with internal and external delegates and any operations associated with the Care Management department. 

Ensures the CM department performs the following: All contracts [(i.e. Centers for Medicare and Medicaid Service (CMS), California Department of Health Care Services (DHCS)], California Department of Managed Health Care (DMHC) regulations, applicable state and federal regulations, National Committee on Quality Assurance (NCQA) CM Certification, Management Services Agreements & Other Contracts. 

Oversees and monitors operational compliance with organizational standards, policies and procedures and regulatory requirements.

Assures department meets all regulatory time frames on CM.

Develops and implements departmental policies and procedures. 

Develops and maintains departmental statistical and performance reports. 

Develops, implements and monitors performance standards.

Develops and maintains effective communication mechanisms at various levels of the organization and with external organizations. 

Develops and maintains departmental budgets in line with organizational goals.  Assures operational effectiveness to meet MCR targets and optimize health care resource utilization. 

Required:

At least 8 years of Care Management experience including progressively responsible leadership experience facilitating quality/process improvement, updating policies/procedures with the latest regulatory and accreditation standards. 

At least 6 years of leading staff or supervisory/management experience.

At least 3 years of relevant Health Plan experience.

Required:

Excellent verbal, written and presentation skills.

Critical thinking skills.

Ability to think strategically and build continuity between programs.

Ability to efficiently and effectively assimilate information and communicate clearly and promptly to key stakeholders.

Ability to analyze and identify trends in reports to facilitate decision for enhancements to program.

Proven effective leadership skills.

Proficient with MS Office (Word, Excel, Outlook, PowerPoint, etc.)

Motivational interviewing skills.

Knowledge of compliance standards in the operational function.