The Director, Ambulatory Care Management and Operations, is responsible for the leadership, operational oversight, and overall performance of the Value Based Services Organization’s care management team and clinical programs across a matrix organziation. This role ensures full compliance with all regulatory and program requirements while advancing initiatives that improve patient outcomes, optimize resource utilization, enhance care coordination, and support organizational growth. The Director provides leadership and direction to ensure safe, efficient, therapeutic, and ethical care management practices, fostering a collaborative environment among clinical, operational, and administrative teams. The Director has full supervisory responsibility for Ambulatory Care Management Managers and other designated staff, including recruitment, hiring, termination, performance management, mentoring, and professional development. This role collaborates with senior leaders in the development of departmental goals and strategic initiatives and oversees the implementation and continuous improvement of ambulatory care management programs. The Director ensures that care management models are supported by robust clinical content, evidence-based guidelines, and standardized processes, including assessments, care planning, patient education, and outcome measurement. Leveraging advanced clinical expertise and strong operational leadership, the Director integrates case management, utilization management, quality management, discharge planning, and post-acute coordination into a cohesive, patient-centered strategy. The role ensures medical services, across inpatient, outpatient, and post-acute settings, are delivered at the most appropriate level of care based on patient needs, while reducing care gaps, eliminating unnecessary duplication of services, and controlling costs without compromising quality. In collaboration with physicians, care managers, interdisciplinary teams, and USC Employee Health Plan partners, the Director ensures timely and effective care transitions, drives measurable improvement in key performance metrics, and supports value-based care initiatives (ACO, HMO, Employee Health Plan, Etc.). This role also serves as a subject matter expert and consultant to leadership and clinical teams, ensuring ambulatory care management strategies are aligned with organizational priorities, regulatory standards, and emerging best practices.Essential Duties:Responsible for overall program development and implementation: -Serves as a senior leader resource in collaborating with executives to establish program objectives and develop enterprise-level ambulatory care management strategies and solutions. -Contributes to the development of business requirements for each ambulatory care management program, ensuring alignment with organizational goals and compliance with regulatory standards. -Defines, documents, and refines key processes necessary to support sustainable, high-performing programs. -Oversees the development of clinical content, including but not limited to assessments, evidence-based clinical guidelines, and patient/family education materials. -Directs the creation and delivery of orientation, training, and ongoing competency programs for departmental staff. Establishes and monitors program process measures and outcome metrics, ensuring regular evaluation of program impact and effectiveness.Managing the program’s services, outcomes, and resources/staff: -Provides leadership and oversight of program operations and staff performance, including recruiting, hiring, mentoring, and supporting professional development for all program positions. -Ensures that medical services across inpatient, outpatient, and post-acute settings are delivered at the most effective and appropriate level of care based on the patient’s medical needs. -Builds and sustains high-performing teams that can meet both current and future program goals and objectives. -Oversees workload distribution, productivity, and effectiveness of staff, ensuring operational and clinical goals are met. -Leads collaboration with interdisciplinary teams (IDT), facilitating forums, and supporting care managers in providing coordinated services that promote cost-effective, high-quality outcomes. -Serves as a clinical and operational consultant to ambulatory care managers, providing second-level expertise and problem-solving support for complex patient care decisions. -Oversees and ensures comprehensive documentation for patients in this program, including but not limited to network and out-of-network hospitalizations, SNF stays, observation status, discharges, CCM census, new assessments, and interventions. -Ensures departmental compliance with all applicable regulatory and accreditation standards, including health plans, NCQA, Joint Commission, federal and state requirements, and internal Health System policies.Responsible for clinical leadership in ambulatory care management with patient and physician engagement: -Leads and participates in care management activities to ensure that newly implemented processes, programs, and workflows are effective and sustainable. -Analyzes and evaluates care delivery processes to identify and address gaps, reduce unnecessary duplication, and maintain cost-effective, high-quality care. -Applies advanced clinical knowledge and experience in assessment, planning, implementation, and evaluation to the oversight of care management activities. -Maintains expertise in applying current clinical guideline-based criteria, including but not limited to CMS, InterQual, MCG, and health plan standards.Employee Management: -Ensure that management staff understand basic wage and hour laws, federal, state and local laws and regulations, Medicare, and legislation affecting employment in outpatient and nursing services -Plan, organize and supervise all clinical and support staff(s) to ensure high quality, cost effective patient care -Direct and approve staffing plans to promote the maximum use of all personnel and the reduction or addition of staff based upon patient load ratios and organizational outpatient guidelines -Ensure that continuing education programs are offered to keep staff up to date on nursing practices, universal precautions, worker/patient safety etc. -Responsible for all employee activity such as hiring, promotions, performance evaluations, salary increases, and disciplinary actions with appropriate approvals from the Executive Administrator and HR Administrator; includes all bonuses, performance reviews, employee performance management, compensation reviews, etc. -Ensure that the performance evaluation program meets organizational guidelines. -Lead regular staff meetings with Clinic Administrators or other program facilitators as necessaryPerforms all duties as assigned.Required Qualifications:Req Bachelor’s Degree Nursing BSNReq 5-10 years Five plus years of clinical experience with three plus years of experience in ambulatory case management in a leadership role.Req Demonstrated leadership ability, team management and interpersonal skills. Ability to effectively communicate with personnel from diverse backgrounds.Req Ability to manage multiple projects with effective prioritization.Req Strong written and verbal communication and interpersonal skills.Req Excellent analytical, critical and abstract reasoning skills, plus excellent organization skills.Req Intermediate to advanced computer skills in Microsoft Office programs including Word, Excel, and PowerPointReq Knowledge of CM standards, UM standards, clinical standards of care, NCQA requirements, CMS guidelines, Milliman guidelines, InterQual guidelines, and Medicaid/Medicare contracts and benefit systems is preferred.Preferred Qualifications:Pref Master’s degree Nursing MSNPref 3 years Three plus years experience in an HMO/IPA/Managed care setting is preferred.Pref Certified Case Manager – CCM (CMSA)Pref Certified Utilization Review ProfessionalRequired Licenses/Certifications: Req Registered Nurse – RN (CA Board of Registered Nursing) Valid California Registered Nurse license.Req Basic Life Support (BLS) Healthcare Provider from American Heart AssociationReq Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)The annual base salary range for this position is $133,120.00 – $219,648.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.
