Sr Dir, Medi-Cal/Cal AIM Care Mgmt Programs

Independent Living Systems • Glendale, CA

3d

About The Position

The Senior Director, Medi-Cal/Cal AIM Care Management Programs will lead the strategic development and operational execution of comprehensive care management programs aimed at improving patient outcomes and optimizing healthcare delivery. This role involves strategic planning, program development, operational management and clinical oversight for care coordination, utilization management and population health programs (CalAIM, Managed Care), to ensure the delivery of high-quality, person-centered care that addresses social determinants of health and promotes community engagement. The Senor Director will ensure regulatory compliance (DHCS), drive quality metrics and lead teams to support high risk members. This role is pivotal in designing and implementing innovative care coordination strategies that address complex patient needs across diverse populations. The Senior Director will collaborate with clinical teams, community partners, and stakeholders to ensure seamless integration of services and adherence to regulatory standards. By leveraging data analytics and evidence-based practices, the Senior Director will drive continuous quality improvement and cost-effective care solutions. Ultimately, this position is responsible for fostering a patient-centered culture that enhances care experiences and supports population health goals nationwide.

Requirements

• Master’s degree in Social Work, Psychology, Biology, Public Health, Nursing, Community Health, or Health related field.
• Requires current RN licensure in the state of California.
• Requires at least 7-10 years of progressive experience in care management, case management, or population health management, with at least 5 years in leadership.
• Requires knowledge of and experience working with community agencies and programs.
• Requires 6+ years of clinical/operational leadership in complex healthcare environments, with 5+ years at a director/manager level in utilization or care/case management.
• Expertise in California specific regulations (Medi-Cal, Cal AIM).
• Requires strong problem-solving and customer service skills.
• Must be a CA Resident and must reside in CA while employed.
• Current and valid California (CA) Driver’s License.
• Must use personal vehicle and current vehicle registration required.
• Proof of auto insurance required, must maintain CA minimum insurance coverage.
• BCLS CPR Certification required.
• Relevant experience may substitute educational requirement on a year-for-year basis.

Nice To Haves

• Certification in Case Management (CCM) or Certified Professional in Healthcare Quality (CPHQ).
• Experience working with Medicaid, Medicare, or other government healthcare programs.
• Familiarity with electronic health records (EHR) systems and health information exchanges (HIE).
• Proven success in implementing innovative care management technologies and strategies.

Responsibilities

• Develop and oversee enhanced care management programs that align with organizational goals and regulatory requirements.
• Lead multidisciplinary teams to coordinate care plans for high-risk and complex patient populations.
• Develop and oversee enhanced care management programs that align with organizational goals and regulatory requirements.
• Develop and implement comprehensive care management models, incorporating risk stratification, LTSS, and population health to meet organizational needs.
• Oversee daily operations, including utilization review, discharge planning and complex case management, ensuring compliance with state (DHCS) and federal regulations.
• Establish partnerships with healthcare providers, community-based organizations, and payers to facilitate integrated care delivery.
• Monitor program performance through data analysis and reporting, implementing improvements as needed to achieve quality and efficiency targets.
• Ensure compliance with healthcare laws, accreditation standards, and best practices in care management.
• Manage budgets, resources, and staffing to support program sustainability and growth.
• Collaborate with IT and analytics teams to utilize health information technology for enhanced patient tracking and outcome measurement.
• Represent the organization in external forums, advocating for enhanced care management initiatives and policies.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager