Director, Case Management Nurse Management

Your Role

The Director of Transitional Care Services reporting to the Sr Director, Population Health Management, will work to implement whole person integrated healthcare by leading Care Management for the MediCal member population. This role will provide leadership, direction, and oversight to our Medi-Cal Transitional Care Services team and ensure that our beneficiaries receive case management interventions and linkages to essential services while residing in an inpatient setting and post-discharge. Services will include linkage to PCPs and specialist and linkage to other supportive services such as CalAIM Enhanced Care Management, CalAIM Community Supports, the Community Health Worker Benefit and Long-Term Services and Supports. This leader will support the Population Health program designed to engage members, reduce disparities and gaps in care, and improve quality for our Medi-Cal members. This position will drive member experience and engagement, improvement in the overall health of Blue Shield of California members, and affordability and efficiency. The Director contributes to the overall strategy and goals of the Medical Care Solutions organization. This role is being created in compliance with the MediCal mandate requirement outlined by the Cal-AIM Population Health Management program.

Your Knowledge and Experience

• College degree or equivalent experience required.
• Advanced degree commensurate with field preferred.
• Must maintain active, unrestricted CA RN license or current LCSW, LMFT, LPCC, or PsyD by the Board of Behavioral Health Sciences
• A minimum of 6 years' experience successfully managing people and leading teams.
• Certified Case Manager (CCM) or is in process of completing certification when eligible based on CCM application requirements or National Certification in related field.
• A minimum of 6 years' progressive leadership experience in Medi-Cal care management, transitions of care, or related clinical operations.
• A minimum of 10 years' combined experience managing projects, programs, complex change initiatives, and/or CMS, NCQA and DHCS audits and regulatory compliance
• Experience in care management and/or transitions of care services, at a health plan or similar health care organization structure
• Working knowledge or experience in utilization management at a health plan or similar healthcare organization structure, with the ability to support or lead integration efforts if future models include closer alignment between UM (concurrent review) and care management activities.