Job Description

The Director of Clinical Operations, RN is responsible for overseeing the Inpatient Case Management operations, with a strong focus on clinical and technical components. This leadership role includes working closely with the Vice President of Clinical Services and other key personnel to plan, develop, and implement inpatient medical management programs that align with strategic, operational, and budgetary goals. The Director is also responsible for ensuring compliance with health plans, state and federal regulations, and accreditation processes.

Key Responsibilities:

• Program Development & Compliance: Collaborates on creating and implementing medical management programs. Ensures policies comply with health plan, state, and federal requirements (e.g., DMHC, CMS, NCQA).
• Audit & Training: Reviews denial processes, assists with audits, and identifies areas needing staff development. Coordinates training and ensures adherence to regulatory requirements.
• Operational Management: Oversees day-to-day operations, employee performance, and productivity within the Inpatient Case Management department. Ensures timely and accurate completion of processes.
• Leadership & Staffing: Manages team performance, provides training, and resolves performance issues. Develops and implements performance goals.
• Program Outcomes & Cost-Effectiveness: Develops outcomes to justify program continuation and cost-effectiveness. Monitors and reports on key compliance metrics.

Qualifications:

• Education: BSN (Bachelor of Science in Nursing) from an accredited institution required; a Master’s degree is preferred.
• Licensing: Active California RN license required.
• Experience: 3-5 years in case management or discharge planning and management experience in case management. Experience with health plan audits and NCQA is preferred.
• Certifications: Case Management Certification (CCM) preferred.

Compensation & Benefits:

• Salary: $150,000 - $160,000, depending on experience.
• Total Compensation: May include sign-on bonuses, discretionary awards, and comprehensive medical, dental, vision, and life insurance.
• Retirement & Time Off: 401(k), paid time off (vacation, sick days, parental leave), and various other benefits.
• Additional Benefits: Tuition reimbursement, mileage, employee assistance programs, and more.

This role requires a highly organized, clinically experienced leader with strong management skills who can navigate complex regulatory environments and drive performance improvements across inpatient case management.

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Job Tags

Similar Jobs