Director of Clinical Operations

$150,000 - $150,000/Yr

CareNational Healthcare Services - Los Angeles, CA

Full-time - Senior

Los Angeles, CA

Administrative and Support Services

About the position

The Director of Clinical Operations is a senior-level position responsible for overseeing the Inpatient Case Management operations at CareNational Healthcare Services. This role involves both clinical and technical responsibilities, ensuring compliance with health plan and regulatory requirements while promoting cost-effectiveness and quality improvement. The Director collaborates with various stakeholders to develop and implement medical management programs, conducts audits, and provides training to staff, all while managing day-to-day operations and ensuring optimal performance of the department.

Responsibilities

• Oversee all aspects of Inpatient Case Management operations.
• Plan, develop, and implement inpatient medical management programs in collaboration with the Vice President of Clinical Services.
• Ensure compliance with health plan, state, and federal regulatory requirements.
• Review and edit the Inpatient and SNF Denial process for errors and omissions.
• Identify areas for staff development and training through inter-departmental auditing.
• Ensure completion of UM work plans and health plan reports.
• Prepare the department for accreditation with the Medical Management team.
• Coordinate Utilization Management Committee meetings and activities.
• Provide consultative services and training for UM participants and facilities.
• Conduct monthly, quarterly, and annual audits, communicating issues and trends to stakeholders.
• Develop and implement individual performance goals for staff.
• Monitor employee production against established benchmarks and initiate corrective interventions as needed.
• Participate in internal QI Plans, Programs, and Activities as directed.

Requirements

• Bachelor's of Science degree in Nursing (BSN) from an accredited nursing school.
• CA RN license.
• Three to five years of related experience and/or training in an acute care setting.
• Five years of experience in Case Management or Discharge Planning.
• Three years of management experience in Case Management.
• Case Management certification (CCM) preferred.
• Experience with health plan audits/compliance and NCQA requirements strongly preferred.

Nice-to-haves

• Master's degree in a related field.
• Experience with CMS and ICE UM processes/policies/procedures.

Benefits

• Competitive salary of $150,000 per year.
• Opportunities for professional development and training.
• Health insurance options.
• Retirement savings plan options.