Director, Care Management
HealthCare Partners - Torrance, CA

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Associate's Degree Nursing
  • CA RN License
  • More than 5 years of experience required
  • HEALTHCARE PARTNERS MEDICAL GROUP, a division of DaVita HealthCare Partners, Inc. (DVA: NYSE), is a top-rated southern-California medical group and is widely recognized for its achievements in clinical excellence and patient satisfaction. Founded in 1992, we have grown to provide care for more than 660,000 patients throughout Los Angeles and Orange counties. We own and operate 66 medical offices, and our affiliated physician network consists of more than 6,000 primary care physicians and specialists who represent the diversity of the areas we serve. HealthCare Partners also owns urgent care centers, walk-in care centers, and ambulatory surgery centers. In addition, we operate affiliated physician groups in Florida, Nevada, and New Mexico. HealthCare Partners has been recognized nationally for healthcare innovation and excellence. W e are committed to bringing the benefits of coordinated care to our patients and to taking a leading role in the transformation of the national healthcare delivery system to assure quality, access, and affordable care for all. If you're looking to make a difference with a large, financially stable, well-recognized medical group, HealthCare Partners may be the employer for you. HealthCare Partners was voted one of the “Best Places to Work” in Los Angeles County and Orange County in 2012.

    We are currently seeking a Director, Care Management. This immediate opportunity will be responsible for overseeing the management and optimization of centrally based CM departments and functions. Oversight includes: Transplant, Out-of-Area, and Inpatient Central. Develops and implements procedures in coordination with the Regions for transfer of care processes between the inpatient and ambulatory care settings. Also acts as liaison with company wide contracted entities such as Home Health and DME vendors. Acts to support the contracting department as the clinical subject matter expert in ancillary contract negotiations.

    ESSENTIAL FUNCTIONS: Oversees and supports CM Central departments: Transplant, Out-of-Area and Inpatient Central, ACO department. Develops reports and metrics to be used for productivity, adherence, and outcome measurements. Monitors and performs analysis of metrics associated with these departments. Ensures departments optimize workflow efficiencies to meet company objectives. Provide supervision, guidance, and mentoring to managers and staff reporting to this position. Identifies opportunities that these departments can implement to support financial goals of organization. Acts as subject matter expert to contracting department in negotiation of ancillary contracts. Ensures that service standards are implemented and adhered to by company-wide vendors (e.g., home health, DME). Leads and/or participates in company-wide assigned projects that deal with CM/UM processes. Coordinates and supports roll out of CM processes to the Regions in cooperation with the Vice Presidents, Regional Care Management. Act as Regional support to CM in areas of benefit interpretation, injectable process, vendor compliance, and CM process flow issues.

    Qualified candidates will have Bachelor’s degree from a four-year college and/or a professional certification requiring formal education beyond a two-year college. Graduate from an accredited school of Nursing. Current California RN license. Case Manager (CCM) certificate preferred. Minimum 7 -10 years experience including case management, utilization management, discharge planning experience required, minimum 3-5 years management level experience. Background in medical group / IPA, or HMO setting preferred. Strong working knowledge of benefit plans primarily with PPO, Medicare and FFS. Computer literate, proficient in Microsoft applications (Word, Excel, PowerPoint, Access), Excellent verbal and written communication skills.

  • HealthCare Partners - 2 years ago - save job
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    Since 1992, HealthCare Partners has been committed to developing innovative models of healthcare delivery that improve our patients' quality...