Corporate Director of Care Management - PHMI EE Benefits in Ontario, CA at Prime Healthcare

Date Posted: 10/2/2020

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    3480 East Guasti Road
    Ontario, CA
  • Job Type:
  • Experience:
    At least 7 year(s)
  • Date Posted:
    10/2/2020

Job Description

Responsibilities The Corporate Director of Care Management is accountable for the strategic and operational excellence of the Care Management within the self-insured Employee Health Plans, including administrative and care cost initiatives, system development and delivery of high-quality outcomes, compliance with all State and Federal regulations that affect Care Management activities and executive level reporting and communication as needed. The Corporate Director works closely with the Corporate Chief Medical Officers and EHP Department, including Utilization Management and Customer Service, to collaborate on Utilization Management, Care Management, Disease Management, Health Plan Management, as well as Business Intelligence/Analytics, Quality Management. The Corporate Director interprets key performance metrics to develop plans and achieve the Care Management outcomes relative to improved experience of care and appropriate resource utilization.

 

#LI-CC1

Required qualifications:

  1. Bachelor’s degree in Nursing, Healthcare Administration, or another relevant field
  2. A minimum of seven (7) years’ experience in Care Management, Medical Management, Clinical Utilization Review or Case Management with a large Health Plan and/or Managed Care Organization
  3. An active CA Registered Nurse license
  4. Current BCLS (AHA) certificate upon hire and maintain current
  5. Analytical ability for problem identification and assessment and evaluation of data/statistics obtained from an on-going review process
  6. Knowledge of Milliman Care Guidelines, InterQual Criteria, and CMS Criteria
  7. Knowledge of self-funded health plans, ERISA and HIPAA guidelines
  8. Experience and knowledge in intermediate computer skills (i.e. Microsoft Word, Excel)
Preferred qualifications:

  1. Master’s Degree in Nursing, Healthcare Administration, or another relevant field
We are an Equal Opportunity/Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics.  If you need special accommodation for the application process, please contact Human Resources.  EEO is the Law: https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf