Associate director of care & utilization management

A Associate Director of Care & Utilization Management (ADCUM) contributes to AHF by blending the Mission and Core Values with care coordination processes and functions. The ADCUM provides operation oversight of the Health Plan Care Management (CM) & Utilization Management (UM) departments, and is responsible for the establishment and achievement of the Care Management Division (CMD) goals and objectives for this team. The ADCUM ensures consistent, high-quality care delivery that align with organizational goals. This role oversees daily operations of the CM & UM teams, including staffing models, workflows, and performance standards. The ADCUM also collaborates with front line team members and leadership to execute the Model of Care, meet CM & UM standards/performance metrics and maintain regulatory compliance; thereby, improving health outcomes, preventing hospital readmissions, enhancing clinical patient safety, reducing medical errors, promoting health equity, overcoming Social Drivers of Health (SDOH) barriers, leads CM & UM-related quality improvement initiatives, promotes effective clinical data exchange, and coordinates patient-centered care to optimize health outcomes, close care gaps, reduce healthcare costs, and ensure compliance with organizational and regulatory standards and improving patient satisfaction and retention rates.

The ADCUM demonstrates strong leadership skills clinical skills, proactive thinking, comprehensive knowledge of healthcare rules and supportive services, with a special focus dedicated to HIV/AIDS members, ensuring that all members have access to a comprehensive set of services based on their needs and preferences across the continuum of care. A ADCM enhances the reputation of AHF by maintaining the AHF Management Philosophy principles, which is inclusive of the following elements: Mission Driven, Fairness, Learning, Hands On, Accountability and Tenacity. The ADCUM also utilizes core nursing principles, including Autonomy, Beneficence, Non-maleficence, and Justice, which promotes patient-centered, compassionate care, as well as Fidelity, Veracity, Accountability, and Compassion, which promotes professionalism and patient advocacy. Combining these principles will facilitate meeting members where they are, help identify patient strengths and barriers, and assist patients with realistic goal setting to improve health outcomes, health equity, and quality of life.

You will be a passionate advocate for our top initiatives.

To be successful as a ADCUM it is crucial to ensure that the AHF Core Values and Mission stay top of mind with all that you do. At AHF we are nimble and able to adapt in a dynamic environment to assist in providing the best experience for our clients and workplace for our employees.

AHF has a collaborative organizational structure where staff are accountable to multiple leaders.

The ADCUM will work as a part of a close-knit team to drive standardization and operational excellence across the care coordination team, partner with Quality Management leadership to support HEDIS/MCAS, STARs, and utilization targets, monitor care management impact on admissions, readmissions, ED utilization, and total cost of care, ensure CM & UM activities meet CMS, NCQA, DHCS, and DMHC requirements, lead audit preparation, documentation standards, and corrective actions as needed. The ADCUM will support budgeting, workforce planning, and productivity monitoring, provide leadership, coaching, and performance management for care coordination staff, collaborate with the interdisciplinary team to analyze member outcomes, evaluate the utilization of plan benefits and develop solutions to improve both member health outcomes and health plan fiscal outcomes, demonstrate a caring and compassionate focus, and foster a culture of accountability, collaboration, and continuous improvement.

The ADCUM will also maintain a comprehensive knowledge of the CMD Model of Care, Health Plan Accreditation Standards, and county/state/federal regulations and guidance, including All Plan Letters, HPMS memos and contract deliverables, and provide updates to the team on a routine basis.

Licenses and Certifications: RN & BSN required, MSN preferred. 5+ years of Nursing Experience required. 2+ years of Nursing Leadership required. 2+ years Managed Care experience required.

Bilingual Spanish preferred

Qualifications AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation!

Does the idea of doing something that really makes a difference in people's lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees?

If so, AIDS Healthcare Foundation is the place for you!

Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them.

AHF's core values are:

• Patient-Centered
• Value Employees
• Respect for Diversity
• Nimble
• Fight for What's Right

Please review our Advocacy page for the latest news on how AHF is Fighting for What's Right! Advocacy News. https://www.aidshealth.org/advocacy/

Benefits at AHF

AHF offers comprehensive benefits to help our employees do and be their very best! These benefits are intended to enhance employee physical, financial, spiritual and professional health.