Director of Clinical Services, RN - AppleCare Medical - Buena Park, CA

AppleCare Medical was formed in 1996. Over the last 19 years, the multispecialty medical group of independent practices has expanded into new communities, contracted with more hospitals and health plans, and added over 50 new doctors - but the mission has remained the same. Today, AppleCare Medical Group is comprised of hundreds of board-certified private-practice, independent physicians. Collectively, our physicians have been serving the Southeast area of Los Angeles and Northern Orange County for decades, providing their medical expertise and passion to improving the health of our communities.
 
As a part of our continued growth, we are searching for a new Director of Clinical Services to join our team...
 
The Director of Clinical Services is responsible for the direction, oversight and facilitation of the Care Management Program. In addition, this role is responsible for ensuring that all case management functions meet all state and federal regulatory requirements.      
 
KEY RESPONSIBILITIES:


Provides leadership and direction to Care Management staff and programs.

Performs personnel counseling and develops & implements performance improvement plans.

Identifies outpatient clinical efficiencies and assists the Vice President of Clinical Services in the development and implementation of UM programs.

Works collaboratively with Inpatient Management, Outpatient Management, and Quality Management leadership.

Identifies high dollar / high risk cases

Provides senior management with analysis of Care Management Programs.

Assists in the development and implementation of clinical service staff and provider training programs.

Participates in UMC/QIC, PCP, Provider Office Meetings, health plan JOMs, and hospital JOCs.

Provides feedback to Vice President of Clinical Services regarding process improvements.

Monitor and ensure compliance with Model of Care for SNP (Special Needs Plan) and CMC (Cal Medi Connect) plans.

Provides senior leadership with analysis of the Care Management Report.

JOB REQUIREMENTS:

Current RN license in the state of California
3 or more years of Managed Care/IPA/Health Plan experience
3 or more years of Management experience
3 or more years of  Case Management experience
Excellent written and verbal communication skills
Computer proficiency in MS Office: Outlook, Word, Excel, PowerPoint
PREFERRED EXPERIENCE:

Certified Case Manager - CCM
Bachelors Degree in Nursing
 
Careers with AppleCare Medical. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. AppleCare Medical brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. AppleCare Medical Group, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
 
AppleCare Medical is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.