Senior Director, Care Management RN

Description

Calling All Visionary Leaders!

Are you ready to make a difference in healthcare management? We are seeking a dynamic and strategic leader to join us as the Senior Director of Care Management - Utilization & Appeal Management. If you thrive on transforming healthcare delivery and improving patient care, we have the perfect opportunity for you.

The Role:

As Senior Director of Care Management - Utilization & Appeal Management, you'll collaboratively lead, coordinate, and support care management activities for the South Division. Working alongside the Executive Director, Care Management - South, your leadership will drive strategic vision and operational excellence.

What You'll Do:

• Lead with Strategy: Provide divisional leadership and strategic planning to operationalize standard utilization and appeals management within Providence South Division.
• Goal Setting & Evaluation: Develop divisional goals and action plans, implementing program evaluations to ensure success.
• Implement Best Practices: Identify and implement best practices in Utilization Management, Appeals Management, and Post Acute Continuum of Care.
• Drive Process Improvements: Sponsor and lead operational excellence initiatives, actively addressing inefficiencies and implementing corrective actions.
• Collaborate & Coordinate: Lead division-wide care management teams, acting as liaison to Regional Business Office and Regional Compliance for denials management.
• Build Partnerships: Foster positive relationships with managed care organizations to improve communication and reduce denials.
• Ensure Compliance: Maintain adherence to federal, state, and local compliance requirements across the division.
• Promote Collaboration: Facilitate best practices in utilization and appeals management across South Division entities.
• Measure Success: Analyze and report key metrics related to utilization and appeals management, driving continuous improvement.

What You'll Bring:

• Educational Background: Master's Degree in Nursing, Health Administration, or related discipline, with a California Registered Nurse License.
• Experience: 6 years of clinical/operational leadership in complex healthcare environments, with 5 years at director/manager level in Utilization Management, Appeals Management, or Case Management.
• Expertise: Ability to develop and implement programs focused on utilization management, appeals management, and clinical case management training.
• Skills: Strong interpersonal, analytical, and problem-solving skills, with a commitment to driving improvements and sustaining change.

Why Join Us?

• Make a Real Impact: Be part of an organization dedicated to transforming healthcare and improving lives.
• Innovative Environment: Work autonomously and receive support to bring your visionary ideas to life.
• Collaborate with Experts: Join a team of talented professionals passionate about their work.
• Drive Excellence: Thrive in a dynamic and fast-paced industry, making a lasting impact.

Ready to Shape the Future of Healthcare?

If you're a visionary leader with a passion for healthcare, we encourage you to apply! Join our team and help us create a healthier future for all.

About Providence

At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.

About the Team

The Sisters of Providence and Sisters of St. Joseph of Orange have deep roots in California, bringing health care and education to communities from the redwood forests to the beach shores of Orange county - and everywhere in between. In Southern California, Providence provides care throughout Los Angeles County, Orange County, High Desert and beyond.

Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care. Our not-for-profit network provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care, and even our own Providence High School.

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

Requsition ID: 358765

Company: Providence Jobs

Job Category: Care Management

Job Function: Clinical Care

Job Schedule: Full time

Job Shift: Day

Career Track: Leadership

Department: 7000 UTILIZATION MGMT ADMIN

Address: CA Irvine 15480 Laguna Canyon Rd

Work Location: Providence System Offices Discovery Park-Irvine(HR))

Workplace Type: Hybrid

Pay Range: $107.35 - $171.63

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.