Director, Care Management RN

Description

Calling All Esteemed Leaders! Are you a collaborative care management leader with a passion for improving patient flow, strengthening care coordination, and advancing outcomes across multiple hospitals? Do you thrive in complex environments where operational alignment, physician partnership, and data-driven improvement are critical to success? This leadership opportunity invites your expertise.

The Role

The Director, Care Management provides leadership and oversight of Care Management services across Santa Rosa Memorial Hospital, Petaluma Valley Hospital, and Healdsburg Hospital.

This role is responsible for ensuring an integrated approach to utilization management, discharge planning, care coordination, and social services across all three facilities. The Director focuses on improving patient flow, reducing barriers to care, and supporting safe, timely transitions throughout the continuum of care.

The Director works closely with hospital leadership, medical staff, and community partners to align workflows, standardize best practices, and maintain regulatory compliance. This position plays a critical role in driving performance, optimizing resource utilization, and supporting consistent, high-quality patient care across the Sonoma region.

What You'll Do

Multi-Hospital Leadership & Integration

• Lead and coordinate Care Management operations across SRMH, PVH, and HH, ensuring aligned workflows, consistent standards of practice, and systemwide collaboration.
• Ensure seamless integration of services across all sites, promoting continuity, reliability, and shared accountability.

Performance, Outcomes & Throughput Improvement

• Monitor, analyze, and improve key performance metrics, including length of stay, avoidable days, readmissions, and discharge efficiency.
• Implement standardized throughput processes to enhance patient flow across emergency, inpatient, and post-acute transitions.

Interdisciplinary & Physician Collaboration

• Partner with medical staff and physician advisors to resolve barriers to care and support evidence-based utilization management.
• Develop strong relationships with Nursing, Quality, Social Services, and ancillary departments to support cross-campus coordination.

Regulatory, Accreditation & Compliance

• Ensure compliance with CMS, CDPH, The Joint Commission, EMTALA, payer requirements, and internal system policies.
• Oversee regulatory readiness activities and ensure consistent documentation standards in utilization review and discharge planning.

Operational & Strategic Leadership

• Evaluate and design staffing models, departmental structures, and resource allocation across all sites.
• Lead strategic initiatives supporting care transformation, population health priorities, and community integration.

Fiscal Stewardship

• Assume accountability for fiscal management of Care Management services across all entities.
• Develop, present, and manage annual budgets, including personnel, supplies, and operational resources.
• Monitor budget performance, analyze variances, and implement corrective actions.
• Monitor payer trends and lead interventions to reduce avoidable denials and improve medical necessity compliance.
• Partner with Revenue Cycle, Physician Advisors, and Payer Relations to improve authorization processes and reimbursement integrity.
• Implement system, technology , and process improvements that enhance efficiency and cost containment.

Divisional Alignment & Standardization

• Align Care Management practices with regional and system-wide initiatives, ensuring consistency in policies, workflows, and documentation across all hospitals.

Workforce Optimization & Talent Development

• Evaluate staffing needs across sites and ensure equitable resource distribution based on acuity, volume, and throughput demands.
• Recruit, retain, and develop high-performing Care Management teams.
• Promote professional growth and leadership development across managers, supervisors, and front-line teams.

Qualifications

Education

• Bachelor's Degree in Nursing
• Master's Degree in Nursing or related healthcare field (preferred)

Certification

• Active California Registered Nurse License (required upon hire; vendor-managed)

Experience & Expertise

• Minimum of 5 years of Care Management experience in an acute care setting
• Minimum of 3 years of progressive leadership experience
• Experience in care management, utilization management, and discharge planning
• Demonstrated ability to lead and integrate Care Management operations across multiple acute care facilities
• Expertise in multi-site workflow optimization, staffing models, and resource allocation
• Strong knowledge of California state regulations, CMS Conditions of Participation, EMTALA, and utilization management requirements
• Experience with survey readiness and multi-facility regulatory compliance (Joint Commission, CDPH, CMS, payer audits)
• Advanced experience using analytics, dashboards, and KPIs to drive LOS, throughput, readmissions, denials, and care outcomes
• Experience with EHR reporting and Care Management systems
• Strong background in operational improvement, clinical redesign, and system standardization
• Knowledge of population health strategies, care transitions, and social determinants of health (SDOH)

Leadership Capabilities

• Ability to build strong relationships with executive leaders, physicians, and interdisciplinary teams
• Strong analytical and data interpretation skills with ability to translate insights into action
• Proven ability to lead across geographically dispersed teams and diverse organizational cultures
• Strong conflict resolution and consensus-building skills
• Demonstrated success driving organizational change and fostering engagement
• Ability to mentor and develop leaders across multiple sites
• Strong financial stewardship and budget management capabilities
• Clear communication and influence across all levels of the organization

Why Join Us?

• Regional Impact: Lead Care Management services across multiple hospitals and communities
• Patient-Centered Work: Improve care transitions and outcomes for complex and vulnerable populations
• Operational Leadership: Drive throughput, efficiency, and care coordination at scale
• Collaborative Environment: Partner with physicians, nurses, and system leaders
• Mission-Driven Care: Advance equitable, high-