Top Managed Care Executive jobs in Long Beach, CA

Executive Director, Care Management

Title: Executive Director, Care Management

Location: Long Beach, CA

Department: Care Coordination

Status: Full-time

Shift: Days

Pay Range*: $182k - $274k/annually

At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. Memorial Care stands for excellence in Healthcare. Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation and teamwork.

Position Summary

The Executive Director of Care Management is the leader of care transitions for Long Beach Medical Center and Miller Children’s and Women’s Hospital, Long Beach and is responsible for the clinical and administrative operations, lean management systems and continuous improvement for inpatient and ambulatory: clinical access, case management, social work, palliative care, multi-specialty care.

Responsible and accountable for care delivery and care coordination systems that support quality patient care that is safe, timely, effective, efficient, equitable and patient/family centered. Maintains clear communication with staff, physicians, health team members, colleagues, executive leadership and MemorialCare system to foster a team approach to problem solving to achieve patient/family centered care that optimizes health outcomes across the care continuum.

Establishes strategic and results oriented tactics, goals and objectives using a collaborative, team approach to deliver excellent patient experience, safety and care progression that is fiscally responsible and meets current and anticipated needs of the community served. Responsible for building relationships and creating partnerships with community organizations to build programs and resources.

Responsible and accountable for working with all hospital departments to maximize throughput, utilization management, authorization, and billing process to enhance outcomes, prevent readmissions and reach organizational fiscal requirements. An executive lead of the Utilization Management Committee. Responsible for key metrics including length of stay, readmissions, authorization related financial performance, referral delays, care progression etc.

Ensures systems and processes are in place to support regulatory and accreditation compliance with state and federal regulations and related accrediting bodies for all programs within the scope of the assigned departments and services within the defined span of control.

Provides supervision and direction to managers to ensure that budgets and staffing resource levels are maintained and stresses accountability for performance expectations. Ensures the necessary human and other resources are available for the delivery of services and programs.

Essential Functions and Responsibilities of the Job

Leads as a professional role model, demonstrating commitment to the organizational values

• Demonstrates professional leadership practices that facilitate improvement and empowerment of management and staff in critical thinking and decision-making using Lean Management Philosophy, Systems and Tools.

• Formulates strategic and results oriented tactics, goals and objectives cascading from the Strategic Plan and executive leadership and MemorialCare system direction.

• Establishes collegial and collaborative relationships with the medical staff, nursing, and inter-professional leaders.

• Attends various designated and associated committee meetings to ensure coordination of efforts.

• Participates in campus wide and MemorialCare initiatives as necessary based on role, or as assigned.

Directs clinical services and care coordination to ensure a safe environment for delivery of high-quality care.

• Implements and directs continuous improvement of clinical quality to achieve outstanding patient and family experience, safety, and timely progression of care.

• Plans, controls, and directs all operational processes for high quality functioning of span of control.

• Directs appropriate personnel action in consultation with Human Resources, as needed, and promotes a Just Culture.

• Directs leaders in appropriate utilization of staffing and scheduling of staff to always ensure productivity and safe environment for care delivery.

• Ensures leadership accountability for safe, efficient, and effective utilization and coordination of staff.

• Develops, implements, and maintains ongoing performance improvement and quality initiatives applying Lean Management Philosophy, Systems and Tools.

• Engages medical staff to ensure integration in inter-professional teamwork and collaboration that promotes effective communication for quality and safety.

Implements and directs continuous improvements to meet organizational fiscal requirements.

• Formulates strategic and results oriented tactics to address revenue enhancement across all departments and settings.

• Engages medical staff and hospitalists to ensure collaboration that promotes appropriate resource utilization, charting and throughput.

• Responsible for key metrics including length of stay, readmissions, authorization related financial performance.

Ensures areas within span of control meet organizational, regulatory and accreditation requirements.

• Educates managers and establishes processes to promote compliance and problem solving with clinical leadership and staff.

• Ensures ongoing survey readiness.

• Ensures oversight of the development of policies and procedures to ensure effective care delivery systems that are created, reviewed, and updated on a timely basis.

• Ensures utilization management, authorization and billing systems meet highest expectations and organizational fiscal requirements.

Promotes professional practice and workforce development.

• Collaborates with teams to develop and implement standards to maintain professional practice that promotes excellence and is consistent with community standards, legislative changes, and current trends.

• Keeps abreast of current healthcare trends to develop administrative and clinical operational improvements that are evidence-based.

• Seeks to establish innovative methods that encourage the retention and recruitment of staff.

• Implements staff educational programs to ensure continuity of staffing with staff competent for related patient conditions.

Ensures control for operating budgets within span of control.

• Preparation of operating budgets that forecast annual needs and reflect requirements for quality patient care delivery including expected changes related to business/health care/contract or community needs.

• Develops monitoring standards to maintain expenditures within budgetary parameters for bi-weekly, monthly, and annual targets.

• Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more...Check out our MemorialCare Benefits for more information about our Benefits and Rewards.

Minimum Requirements

Qualifications/Work Experience:

• Five Minimum 3 years’ successful experience responsible for multiple cost centers and programs.
• Minimum 5 years' care management leadership experience.

Education/Licensure/Certification:

• Master’s Degree required.

• Clinical undergraduate degree preferred.