Nursing Director

Purpose: The Nursing Director provides nursing leadership, program development, supervision, care coordination strategy, clinical protocol oversight, and quality improvement support across Humboldt IPA/PCC programs. The position is responsible for ensuring that complex and high-risk members receive coordinated, person-centered care across outpatient, inpatient, emergency department, and community settings. The role integrates Priority Care intensive care coordination, utilization management, population health measures, hospital rounding, emergency department follow-up, nursing protocols, and shared clinical leadership for the primary care team.

Responsibilities:

Nursing Leadership, Program Oversight & Supervision

• Provide nursing leadership, administrative support, and program oversight for Priority Care Center, utilization management, and population health activities.
• Supervise, mentor, support, care coordination, utilization management, and clinical team members in collaboration with medical and executive leadership.
• Evaluate staffing levels, assignments, workflows, and team roles to improve efficiency, accountability, member outcomes, and department performance.
• Develop and maintain reference materials, workflows, tools, and training resources to assist staff in performing their duties consistently.

Intensive Care Coordination for Complex Members

• Identify, evaluate, and coordinate health care services for members and patients with chronic conditions, complex health needs, high utilization, or significant barriers to care.
• Apply case management standards of care, including screening, assessment, planning, facilitation, coordination, monitoring, and evaluation.
• Establish person-to-person relationships with members while incorporating families, caregivers, providers, clinicians, and support networks into patient-centered action plans when appropriate.
• Take a longitudinal view of care needs over weeks, months, and years, with an emphasis on problem solving, health literacy, self-management, and measurable progress toward health goals.
• Respond to provider referrals, perform and document nursing assessments, answer general health care questions, explain screening results as appropriate, and coordinate delivery of care across settings.

Utilization Management & Resource Stewardship

• Provide leadership for utilization management processes, including review of utilization patterns, care appropriateness, resource use, avoidable emergency department use, potentially avoidable admissions, and ambulatory-care-sensitive utilization.
• Collaborate with providers, health plans, care teams, and administrative leadership to support appropriate level-of-care decisions, timely care transitions, and care management interventions.
• Use best practices, evidence-based guidelines, current research, and regulatory requirements to inform care management, utilization management, and clinical decision support workflows.
• Develop and implement action plans when deficiencies, gaps, or opportunities for improvement are identified through utilization or quality review.
• Provide back-up for sick and vacation time for UM RNs.

Hospital Rounding, Discharge Coordination & Emergency Department Follow-Up

• Round locally on hospitalized members and serve as a clinical liaison between inpatient teams, outpatient providers, care coordination staff, utilization management, and the Priority Care Center.
• Ensure timely transition planning, discharge follow-up, medication reconciliation follow-up, appointment coordination, and communication of the care plan to the outpatient team.
• Work with the team to ensure members seen in the emergency department receive adequate follow-up, outreach, and care coordination after the visit.
• Identify recurring inpatient and emergency department utilization patterns and recommend interventions to improve access, continuity, outcomes, and member experience.

RN/MA Protocols, Clinical Practice Standards & Competency

• Develop, maintain, implement, and monitor RN/MA, and clinic nursing protocols that support safe, standardized, evidence-informed care in clinical settings.
• Develop and maintain nursing policies and procedures that conform to current standards of nursing practice, organizational philosophy, operational policies, and applicable state and federal requirements.
• Communicate and interpret nursing policies and protocols to clinical staff and monitor implementation, adherence, and opportunities for workflow redesign.
• Organize staff training and maintain competency documentation for lab testing, clinic-performed procedures, EKGs, immunizations, chronic disease workflows, care coordination activities, and other patient-related activities requiring training.

Population Health, Disease-Specific Outreach & Quality Improvement

• Work closely with the Quality Improvement Manager to plan, implement, and monitor disease-specific outreach, quality initiatives, preventive care campaigns, and care gap closure activities.
• Develop programs, campaigns, and redesigned workflows to improve population health and utilization measures for health plan members, ACO agreement members, and patients served by PCC locations.
• Use population health, quality, and utilization data to identify care gaps, review trends, prioritize outreach, and evaluate the effectiveness of interventions.
• Support Triple Aim goals by improving health outcomes, improving patient experience, and reducing avoidable utilization where possible.
• Reporting, Regulatory Support & Committee Participation
• Prepare or contribute to reports for Administration, the Board, Quality Medical Administrative Committee (QMAC), Medical Management Committee (MMC), health plan partners, and other regulatory or operational needs as assigned.
• Participate in manager meetings, MMC meetings, QMAC meetings, PCC staff meetings, quality improvement meetings, satellite site meetings, department meetings, and other meetings as appropriate.
• Conduct regular department or program meetings as assigned, including agenda preparation, follow-up items, and documentation of decisions or action items.
• Assist with regulatory, health plan, and internal audits by supporting documentation, policy updates, process monitoring, and corrective action planning.

Collaboration, Community Partnership & Team-Based Care

• Coordinate effectively with IPA physicians, PCC providers, clinic staff, hospitals, community agencies, health plans, public health partners, behavioral health providers, and other health care organizations within Humboldt County.
• Participate in community and cross-organizational efforts that improve population health and access to coordinated care.
• Promote team-based care, role clarity, shared problem solving, respectful communication, and a consistent professional approach across departments and care settings.
• Provide direct patient services as needed to support continuity of care, clinical workflows, staffing needs, or urgent member needs.

Required Qualifications

• Bachelor of Science in Nursing required; RN-BSN level position.
• Current, unrestricted Registered Nurse license in the State of California.
• Minimum three years of nursing experience, including experience in ambulatory care, case management, care coordination, utilization management, population health, or transitions of care.
• Minimum three years of supervisory, clinical leadership, program management, or administrative health care experience preferred for director-level responsibilities.
• Demonstrated ability to apply the nursing process and case management principles to a variety of patients, members, and care settings.
• Working knowledge of health care administration-related regulations and how they apply to IPA, utilization management, primary care, and care coordination operations.
• Ability to interpret and use data for evaluation, planning, workflow redesign, and performance improvement.
• Knowledge of medical office and hospital patient flow, discharge processes, outpatient follow-up, and interdisciplinary communication.
• Proficient computer skills, including documentation, word processing, spreadsheets, data entry, reporting, and electronic communication systems.

Preferred Qualifications

• Experience implementing new programs, protocols, quality initiatives, or population health campaigns.
• Experience with managed care, value-based care, ACO arrangements, health plan measures, or regulatory reporting.
• Experience working with medically complex, high-risk, underserved, older adult, or rural populations.

Work Schedule, Environment & Physical Requirements

• Full-time 32 hours per week, benefited position working four days per week.
• Requires regular on-site presence in PCC/clinic settings and local hospital rounding; may include administrative work, team meetings, field coordination, and community partner communication.
• Must be able to communicate by phone, video, email, and electronic systems; perform documentation and reporting; and travel locally between work sites as needed.
• Must maintain confidentiality and comply with privacy, security, safety, infection control, and professional practice expectations.