Director, Ambulatory Care Operations RN
2 days ago
Fresno
The Director, Ambulatory Care Operations RN serves as the primary clinical and operational relationship leader between the medical network and contracted Primary Care Physicians (PCPs) across the region. This role partners closely with the Regional Medical Director, outpatient providers, care management teams, and internal operational departments to improve continuity of care, strengthen provider engagement, and enhance coordination for high-risk and high-utilizing members. The Director functions as a strategic ambulatory care integrator focused on supporting PCPs with post-discharge coordination, complex patient management, outpatient follow-up compliance, and utilization awareness. This role helps bridge communication and operational gaps between inpatient settings, outpatient providers, care management teams, and health plan resources. The Director proactively engages physician offices to improve patient outcomes, reduce avoidable utilization, support value-based care initiatives, and enhance the overall provider and patient experience. The role emphasizes relationship development, operational problem solving, provider collaboration, and proactive intervention strategies designed to strengthen outpatient care coordination across the continuum of care. This position serves as a key partner to PCP offices by ensuring providers have operational visibility into high-risk patients, recent hospitalizations, emergency room utilization, care coordination opportunities, and available organizational resources to better support their attributed members. A. ESSENTIAL DUTIES & RESPONSIBILITIES PCP Engagement & Relationship Management • Develop and maintain strong working relationships with contracted PCPs, office managers, nursing staff, and outpatient clinical teams., • Serve as a primary operational liaison between PCP offices and Medical Management departments., • Conduct routine provider outreach, engagement meetings, and operational support visits., • Support PCP alignment with organizational clinical, quality, and operational initiatives., • Facilitate communication between outpatient providers and internal departments regarding care coordination, operational barriers, and member needs., • Promote collaborative partnerships focused on improving patient outcomes and provider satisfaction., • Identify operational challenges affecting PCP offices and assist with escalation and resolution. Post-Discharge Coordination & Continuity of Care • Support timely post-discharge follow-up appointments with PCP offices., • Facilitate communication between inpatient teams and outpatient providers following hospitalizations., • Assist PCP offices in managing recently discharged members and high-risk transitions of care., • Collaborate with Transition of Care (TOC) teams to improve continuity and reduce gaps in care., • Help identify and resolve barriers delaying outpatient follow-up or continuity services., • Monitor transition-related workflows and support process improvement initiatives. High-Risk & High-Utilization Member Management • Assist PCPs in identifying and managing high-risk, medically complex, and high-utilizing members., • Provide operational visibility into:, • Frequent ER utilizers, • Frequent admissions, • Readmission patterns, • Rising-risk members, • Complex care coordination needs, • Collaborate with PCPs to support proactive intervention strategies for high-risk populations., • Coordinate with Case Management, Population Health, Behavioral Health, Disease Management, and Social Services teams to support member needs., • Participate in interdisciplinary case discussions and complex patient coordination efforts as appropriate., • Assist in escalating complex outpatient coordination barriers affecting patient outcomes. Population Health & Utilization Collaboration • Support PCP understanding of utilization trends, care gaps, and quality opportunities within their patient panels., • Assist PCPs in identifying opportunities to improve utilization, care coordination, and quality outcomes within their attributed population., • Collaborate with providers on initiatives aimed at reducing avoidable emergency room visits, readmissions, and unnecessary utilization., • Assist with provider education related to:, • Transition of care best practices, • High-risk member management, • Preventive care opportunities, • Care coordination resources, • Quality improvement initiatives, • Partner with internal operational teams to support value-based care strategies and population health initiatives., • Assist with implementation of operational workflows that improve outpatient coordination and patient engagement. Ambulatory Care Integration • Support coordination between outpatient providers and internal departments including:, • Case Management, • Utilization Management, • Behavioral Health, • Quality Management, • Population Health, • Member Services, • Network Management, • Collaborate between inpatient and outpatient care teams across the continuum of care., • Assist PCP offices in navigating organizational resources and escalation pathways., • Promote integrated, patient-centered, and cost-effective care coordination practices. Leadership & Operational Support • Provide leadership, mentorship, and operational support to Clinical Liaison staff as assigned., • Participate in onboarding, training, and development initiatives., • Support departmental process improvement projects and operational initiatives., • Promote a culture of collaboration, accountability, responsiveness, and professionalism., • Assist leadership with identification of operational trends and opportunities for improvement., • Participate in regional clinical and operational meetings as appropriate. B. EDUCATION AND/OR EXPERIENCE Required • Active unrestricted California Registered Nurse (RN) license., • Minimum 5 years of clinical experience., • Minimum 3 years experience in one or more of the following:, • Case Management, • Care Coordination, • Managed Care, • Population Health, • Utilization Management, • Hospital or Ambulatory Operations, • Strong understanding of care transitions and outpatient coordination workflows., • Excellent communication, relationship-building, and organizational skills., • Ability to work collaboratively with physicians, office staff, and interdisciplinary teams. Preferred • Bachelor of Science in Nursing (BSN)., • Experience in IPA, MSO, ACO, or managed care environments., • Experience working with value-based care models and population health initiatives., • Prior physician engagement or provider relations experience., • Experience with high-risk patient management and utilization reduction initiatives., • Bilingual abilities preferred based on regional needs. The pay range for this position at commencement of employment is expected to be between $145,000/year to $150,000/year; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience. The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered. Details of participation in these benefit plans will be provided if an employee receives an offer of employment. If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors. As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success. Full Time Position Benefits: The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life. Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options. Health and Wellness: • Employer-paid comprehensive medical, pharmacy, and dental for employees, • Vision insurance, • Zero co-payments for employed physician office visits, • Flexible Spending Account (FSA), • Employer-Paid Life Insurance, • Employee Assistance Program (EAP), • Behavioral Health Services Savings and Retirement: • 401k Retirement Savings Plan, • Income Protection Insurance Other Benefits: • Vacation Time, • Company celebrations, • Employee Assistance Program, • Employee Referral Bonus, • Tuition Reimbursement, • License Renewal CEU Cost Reimbursement Program, • Business-casual working environment, • Sick days, • Paid holidays, • Mileage
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