To plan, direct and manage clinical service delivery for Geriatrics and Long Term Care in partnership with the Chief of Continuing Care Services; assuring affordable, quality care and service in accordance with regulatory, contractual and accreditation standards/requirements; as well as the organization's mission and goals. Works in close partnership with the department Administrator and Chief of Continuing Care Services in establishing goals, objectives and workplaces for Geriatrics and Long Term Care.
Essential Functions:
- Provides personnel management for employees within the Geriatric and Long Term Care Programs; assuring effective staff/management relationships, communication, problem solving, staff retention and delivery of services consistent with member needs, quality care, regulatory requirements and organization objectives.
- Assures consistent administration of SNF benefit throughout the Northwest Region.
- Manages and oversees budget and operations performance improvement for Geriatrics and Long Term Care including monitoring and improving key quality and utilization management performance measures.
- Works in partnership with the Geriatrics and Long Term Care Team, Chief and CCS Administrator and nursing facility administration to plan and develop programs, maintain and improve quality, maximize utilization management and regulatory compliance within Geriatrics and long term care assuring cost effective, quality care consistent with benchmarked clinical and organizational best practice.
- Provides oversight of quality and utilization management of contract SNF vendors.
- Assures the integration of quality clinical services and for Geriatric and Long Term Care patients and continuity of care across the care continuum through coordination of services with inpatient, outpatient, long term care and contract vendors/ providers.
- Assures maximum effective use of the Long Term Care setting to lower the costs of health care services consistent with quality patient care and clinical outcomes.
- Assures contract SNFs are adequately prepared to meet changing needs of Kaiser Permanente.
- Negotiates service levels and plans for care delivery for patients at SNFs.
- Manages member complaints and appeals, as well as staff grievances.
- Identifies and implements process improvements to prevent complaints and appeals whenever possible.
- Complies with Medicare and NCQA standards to adjudicate member benefits in partnership with department chief or his/her designee.
- Participates as an active member of the department management team in business planning, goal setting, performance improvement and evaluation, contract negotiation, budget and policy/procedure development.
- Substitutes for the department administrator upon request.
- Requires close collaboration with Hospital Discharge Planning teams.
- Primary point of contact for external Skilled Nursing Facilities for program oversight and contract management. - Perform other duties as requested.
Qualifications:
Basic Qualifications:
- Three (3) - five (5) years of progressive supervisory/management experience in operations with at least one (1) - two (2) years in a Home Health/Hospice or long term care setting.
- Five (5) or more years of progressive management experience with two (2) or more years of experience in health care settings/organizations, preferred.
- One (1) - three (3) years of managerial experience within a managed care organization, preferred.
- Previous recent experience as an administrator, director of nursing or resident care manager in a skilled nursing facility, preferred.
- Two (2) - three (3) years of managerial experience within Kaiser Permanente or similar Health Maintenance Organization, preferred.
- Previous experience within Quality/Utilization Management, preferred.
- Bachelor's degree in nursing, physical, occupational or speech therapy.
- Master's degree in nursing, physical, occupational or speech therapy, health care administration or business administration, preferred.
- Professional license required in Oregon or Washington. May be licensed as Registered Nurse, Physical Therapist, Occupational Therapist or Speech Pathologist.
- Valid driver's license with use of own personal transportation (automobile).
- Thorough clinical and administrative knowledge of home health, hospice or geriatrics/ long term care.
- Competency in program planning and development, financial analysis, budget preparation and project management.
- Thorough knowledge of continuous quality improvement and its application in the health care setting.
- Thorough knowledge of adult learning /motivation theory, change theory/management, team development, conflict resolution and negotiation.
- Thorough knowledge of Medicare regulations/ standards governing skilled nursing facility care.
- Demonstrates customer-focused service skills.
- Ability to operate a variety of computer systems including word processing, spreadsheets and data base programs.
- Excellent verbal and written communication, negotiation, delegation, time management and problem solving and conflict resolution skills.
- Thorough knowledge of the managed care industry, preferred.
Salary Range:
$101,660 - $143,540
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.