Identifies & problem solves issues related to the National KP/AMR Ambulance contract. Works closely w/ KP physicians, MOAs, & AMR/Pathways staff to ensure that service is rendered per contract guidelines. Strategize w/ KP Ambulance Project Physician manager & KP Ambulance Project Manager to develop approach to ambulance services in the future.
Essential Functions:
- Provides operational leadership and feedback to staff in the areas of patient transports to ensure alignment with contractual agreements.
- Manages regional ambulance operations and is primary CO Region contact (locally and nationally) for KP and both contract and non-contract providers for medical and non-medical transportation services.
- Provides orientation and instruction to staff, as needed, regarding policies and procedures.
- Co-chairs the KP/RM Local Joint Steering Committee, oversees regional ambulance work plan, reports to the KP/RM National Joint Steering Committee, and actively supports contract negotiations.
- Proactively collaborates with supervisors, ambulance provider representatives, community EMS representatives, Permanente Medical partners, Program Office managers and physicians, regional ambulance stakeholders, and others as needed to direct medical transportation operations.
- Manages and problem-solves issues that arise between KP and Ambulance Vendor regarding transports originating in the Telephonic Medicine Center.
- Reviews ambulance claims to determine appropriate payment. Identifies trends and issues arising from claims review and develops action plan to mitigate impact on the organization.
- Identifies areas of opportunity to improve service, quality, and affordability as it relates to medical transportation services at KPCO and develops/implements plans to address these.
- Identifies Emergency Department high users through a variety of channels and coordinates with medical office personnel to conducts intervention aimed at reducing ED utilization and costs.
- Establishes relationships with external providers (including emergency departments, EMS services) to improve participation in ED high utilizer program and enhance communications regarding member care plans
- Intakes and investigates complaints related to ambulance, emergency services and the Telephonic Medicine Center. Utilizes HealthConnect, Call Management System and NICE to determine what occurred. Reports out to member services and appropriate management.
- Oversees regional repatriation program including working with CPMG, Resource Stewardship and TMC to establish a program that effectively repatriates the appropriate patients at the right time back to KP Core facilities.
- Manages data for repatriation program including tracking of patients repatriated, missed opportunities, and other metrics as needed. Uses data to determine areas of improvement in service, quality and affordability
- Other duties as assigned
Qualifications:
Basic Qualifications:
- bachelor's degree in Business/health administration or related field Equivalent experience may be considered
- 3 yrs experience and knowledge of the Emergency Medical Services Community including any clinical experience as paramedic or EMT
- Experience in quality improvement processes, data management and data analysis
- Strong verbal and written communication skills across all levels of leadership within KP as well as externally
- Proficiency in Microsoft PowerPoint, Visio, Word, Excel, and Access
- Knowledge of healthcare delivery systems and appropriate application of transportation benefits across Medicaid, Medicare, and Commercial patient populations
- Proficient in conflict resolution and team building
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.