Senior Director, Care Management

We are so glad you are interested in joining Sutter Health!

Organization: SHSO-Population Health Services-Valley

Position Overview: Play a critical role in Sutter Health's pursuit to transform healthcare by achieving the highest levels of quality, access, and affordability. Partner with leadership to achieve strategic initiatives such as Total Care Accountability, developing new product offerings and building partnerships related to healthcare reform opportunities. Oversee the planning and execution of care management activities to improve the coordination and transition of care. Develop systems and day-to-day operations to manage care across Sutter Health's continuum of healthcare services—acute, ambulatory, and palliative. Collaborate with to explore optimization opportunities, to identify business efficiencies and linkages, and to encourage cross-organization communication that enhances our competitive advantage and fosters a "One Sutter" face to our patients and their families. Lead and promote system-wide and OU-based best practices related to care management resources, continuity of care, disease management, and clinical outcomes of all case management and social services in both inpatient and outpatient settings. Deliver measurable results that reveal a higher level of quality care through expanded services and performance efficiencies while offering a cost-effective and value-add healthcare environment to our patients, caregivers and customers.

POSITION LOCATION AND TRAVEL REQUIREMENTS: Provides Care Management leadership for Sutter Health’s Sacramento and Central Valley Divisions. Expected to reside within Sutter Health’s geographic footprint. This is a hybrid role, with a combination of remote work and on-site responsibilities. Travel is required to hospitals and other care delivery sites within the assigned divisions, as well as leadership meetings in the Bay Area and Central Valley regions.

Job Description :

POSITION LOCATION AND TRAVEL REQUIREMENTS:

Provides Care Management leadership for Sutter Health’s Sacramento and Central Valley Divisions.

Expected to reside within Sutter Health’s geographic footprint.

This is a hybrid role, with a combination of remote work and on-site responsibilities.

Travel is required to hospitals and other care delivery sites within the assigned divisions, as well as leadership meetings in the Bay Area and Central Valley regions.

EDUCATION:

Graduate of an accredited school of nursing

CERTIFICATION & LICENSURE:

RN-Registered Nurse of California

TYPICAL EXPERIENCE:

15 years of recent relevant experience.

PREFERRED EXPERIENCE:

Experience leading acute care management, utilization management, and social services operations within a multi-hospital health system.

Demonstrated success in improving care progression, length of stay (LOS), patient flow, discharge efficiency, and transitions of care.

Experience developing and implementing standardized workflows, system-wide best practices, and performance improvement initiatives across multiple facilities.

Experience using data analytics, performance dashboards, and industry benchmarks to drive measurable improvements in clinical, operational, and financial outcomes.

Demonstrated ability to collaborate with physician leaders, nursing, finance, managed care, and post-acute care partners to improve care coordination and optimize resource utilization.

Knowledge of regulatory and accreditation requirements, utilization management practices, medical necessity criteria, and payer policies.

Experience leading organizational change, developing high-performing teams, and driving accountability through measurable goals and performance management.

Familiarity with Epic or other electronic health record systems and leveraging technology to improve care management workflows and operational effectiveness.

Experience supporting value-based care initiatives, population health strategies, and partnerships across the continuum of care.

SKILLS AND KNOWLEDGE:

Expert level clinical knowledge in the area of care management principles as they relate to population health as typically acquired during 5-7 years of experience in senior level clinical management

Comprehensive knowledge of Centers for Medicare and Medicaid Services (CMS) Conditions of Participation related to utilization review and discharge, including other federal and state regulations related to case management, social work, etc., across the care continuum

General knowledge of the health benefits business, clinical issues, market trends, medical management, medical care delivery systems, utilization management, quality management, contracting, benefits interpretation, provider relations and government rules and regulations impacting potential health care reimbursement

Working knowledge of state and federal regulations governing immunity for peer review confidentiality

Thorough knowledge of capitation and all of its implications to care delivery operations and management, including demonstrated success at improving the efficiency and effectiveness of large groups of physicians in significant capitated markets

In-depth knowledge of: utilization review, case management, managed care, clinical effectiveness, clinical pathways, disease management, recovery audit contractor (RAC) responses and quality improvement (QI) initiatives

Working understanding of business planning including analysis, statistics, budgeting, feasibility studies and implementation

Understanding of and experience with Lean or other process improvement philosophies and methodologies desired Established ability to define and implement an area-wide care management philosophy, goals and objectives, standards, and policies and procedures to achieve stated objectives while aligning with corporate strategies and goals

Proven skills in leadership, facilitation, organization, prioritization, time management, team building, project management, negotiation and conflict identification and resolution

Demonstrated ability to work within and across all levels of a large health care organization, creating value and buy-in as a key driver of functional and cost-effective continuum of quality care

Written and verbal communication skills, including the ability to translate complex medical and business concepts into lay terms for diverse audiences including ceo's, medical group foundations, independent physician associations (ipas) and hospitals

Superior analytical and problem solving skills, including the proven ability to deliver effective solutions and build consensus, while fostering collaborative working relationships with internal and external constituencies

Exceptional attention to detail, with the proven ability for critical thinking in investigating and assessing complex issues, organizing and analyzing data, interpreting healthcare laws and regulations, andformulating constructive solutions

Advanced level of computer competency in Microsoft Office Suite, as well as other relevant software for research and analysis

These Principal Accountabilities, Requirements and Qualifications are not exhaustive, but are merely the most descriptive of the current job. Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development).

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Job Shift: Days

Schedule: Full Time

Days of the Week: Monday - Friday

Weekend Requirements: None

Benefits: Yes

Unions: No

Position Status: Exempt

Weekly Hours: 40

Employee Status: Regular

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $200,096.00 to $320,153.60 / annual salary

The posted pay range is based on the position's primary work location. Candidates who reside and work outside of that location may be subject to a different pay range based on their work location. Candidate starting salaries consider multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health’s comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.