Title
Authorize the Interim Chief Executive Officer for Natividad Medical Center (NMC) or a designee to execute amendment No. 1 to the agreement with GHR Healthcare, LLC for interim leadership, consulting services, and subject matter expert support, with no changes to the term of October 1, 2025 through September 30, 2027, and adding $200,000 for a revised total agreement amount not to exceed $400,000.
Report
RECOMMENDATION:
It is recommended the Board of Supervisors:
Authorize the Interim Chief Executive Officer for Natividad Medical Center (NMC) or a designee to execute amendment No. 1 to the agreement with GHR Healthcare, LLC for interim leadership, consulting services, and subject matter expert support, with no changes to the term of October 1, 2025 through September 30, 2027, and adding $200,000 for a revised total agreement amount not to exceed $400,000.
SUMMARY:
Interim Director/Lead - Case Management
The Interim Director/Lead will provide operational leadership and oversight of Case Management services, ensuring the department maintains regulatory compliance, effective utilization management, timely discharge planning, and appropriate coordination of patient care. Responsibilities include staff oversight, work flow management, collaboration with physicians and multidisciplinary teams, payer and utilization review processes, discharge planning, performance monitoring, and addressing operational barriers.
The Interim Director/Lead will also establish clear expectations for staff performance, monitor departmental productivity and quality metrics, identify gaps, and implement corrective actions when needed. The role will provide leadership during the interim period while maintaining continuity of services and supporting staff through operational changes.
Staff-Level Case Management Services
Case Management staff will provide daily assessment and coordination of patient care needs, including utilization review, discharge planning, payer authorization, level-of-care determination, post-acute placement, resource coordination, and communication with patients, families, providers, payers, and community partners. Staff will document services timely and accurately and follow applicable regulatory, payer, and organizational requirements.
DISCUSSION
Interim Case Management leadership provides immediate operational support and stability while ensuring that essential Case Management functions continue without interruption. The interim leader can provide day-to-day oversight, establish clear expectations, address workflow and staffing challenges, and ensure regulatory, payer, utilization management, and discharge-planning requirements are consistently met.
This structure also provides an opportunity to evaluate current processes and identify gaps in productivity, documentation, compliance, communication, and discharge planning. Rather than simply maintaining existing operations, the interim leadership can implement standardized workflows, establish measurable deliverables, and create accountability for both leadership and staff.
At the staff level, interim support provides additional guidance, coaching, and oversight while allowing staff to remain focused on patient care coordination. Consistent monitoring of key performance indicators and deliverables allows leadership to identify issues early and take corrective action before they affect patient flow, length of stay, denials, patient experience, or financial performance.
Overall, interim services provide leadership continuity, accountability, operational oversight, and measurable performance improvement while the organization determines its long-term Case Management leadership structure.
OTHER AGENCY INVOLVEMENT:
The Office of County Counsel has reviewed and approved this amendment No. 1 as to form, and the Auditor-Controller has reviewed and approved as to payment provisions. The amendment No. 1 has also been reviewed and approved by NMC’s Finance Committee and by its Board of Trustees on October 2, 2026.
FINANCING:
The cost for this amendment No. 1 is $200,000 of which $150,000 is included in the FY 2026-27 Adopted Budget. Amounts for remaining years of the agreement will be included in those budgets as appropriate. There is no impact on the General Fund with this action.
BOARD OF SUPERVISORS STRATEGIC PLAN GOALS SECTION:
The Case Management strategic plan will focus on creating a Dynamic Organization and Employer of Choice by establishing clear expectations, streamlined workflows, measurable deliverables, and accountability while remaining responsive to changing patient, regulatory, and organizational needs. The department will prioritize staff engagement, professional development, recognition, communication, and teamwork to attract and retain high-performing employees. Success will be measured through improved operational outcomes, compliance, patient flow, employee engagement, and consistent achievement of departmental goals.
__ Well-Being and Quality of Life
__ Sustainable Infrastructure for Present and Future
Safe and Resilient Communities
__Diverse and Thriving Economy
_X_ Dynamic Organization and Employer of Choice
__ Administrative
<https://www.countyofmonterey.gov/home/showdocument?id=139569>
Prepared by: Karen Friedrich, Director of Case Management and Social Services, 831-783-2556
Approved by: Nancy Buscher, Interim Chief Executive Officer, 783-2553
Attachment(s):
Board Report
GHR Healthcare, LLC Amendment No. 1
GHR Healthcare, LLC Agreement
Attachments on file with the Clerk of the Board