Director of Care Coordination

Quick Facts

• Role: Director of Care Coordination

Description

Lead care coordination operations by managing a care coordination team, designing processes, and driving quality and utilization management goals. Work closely with interdisciplinary physicians and leadership to align care coordination activities with program metrics. Ensure compliance with accrediting, statutory, regulatory, and facility-specific standards while monitoring complex cases and performance outcomes.

Responsibilities

• Provide leadership, coaching, mentoring, and performance management for the care coordination team

• Design, implement, and evaluate staffing coverage based on established case management ratios

• Establish care coordination processes and formulate program goals and objectives

• Monitor interdisciplinary rounds and lead complex case reviews

• Develop measurement, monitoring, and evaluation tools for process and outcome performance

• Communicate utilization management goals, trending data, and outcome measurements to senior leadership

• Support change management at the entity level, including population health and capacity management

• Manage operational processes, budgets, and service projections for cost-effective utilization of resources

• Facilitate complex clinical and financial decision-making for higher-approval interventions

• Collaborate with finance and entity analysis to design/interpret utilization and financial performance reports

• Advise the team on LOS, readmissions, difficult discharges, and patient throughput barriers

• Resolve complex payer claims and denials and coordinate coverage for medically necessary services

• Ensure compliance with safety and risk management programs; consult on clinical, legal, regulatory, and reimbursement issues

• Guide case management and social work staff; investigate and respond to client and provider complaints

• Stay current with industry trends and present best practices to leadership

Requirements

• Bachelor’s in Nursing OR Master’s in Social Work OR Master’s (or enrollment with completion within 2 years) in Case Management or Health Administration with relevant acute hospital experience; Social Work candidates must have MSW

• RN license (California) OR LCSW license

• 12 years recent relevant experience

• Knowledge of ACMA, CMSA, and NASW Standards of Practice

• Knowledge of health care delivery and case management in a managed care environment

• Working knowledge of InterQual criteria (preferred)

• Intermediate to advanced PC skills: word processing, spreadsheets, PowerPoint

Benefits

• Comprehensive benefits package as part of a total rewards program

• Pay range: $206,689.60 to $330,699.20 annually (location-based)