This position is responsible for development, planning, management, integration, & delivery of operational system processes & standards of practice, in alignment w/ the organization's mission, strategic business plan, & related performance improvement expectations. In addition, reports to the Executive Director for the Continuum, w/ secondary accountability to Area Managers.
Essential Functions:
- Achieves/exceeds performance expectations for all areas of continuing care operations, including Home Health/Hospice, SNF, DME, Ambulance, Claims & Referrals, & Eldercare, Palliative Care, ESRD, Psych, Social Services, Case Management, Continuing Care UM, Revenue outside the hospital, Shared Continuing Care Services, & H/HP Benefit Application & Contracts
- Joint responsibility for Home Health & Hospice, DME, Ambulance, Utilization Management, Social Services, & Contracts
- Creates structures & processes to develop, implement, & evaluate programs, policies & standards for continuing care services to ensure coordinated plans of treatment, delivery systems that meet member needs, & cost effective utilization of necessary services
- In collaboration w/ local & regional Leadership defines & communicates strategic objectives & scope
- Articulates issues or problems from a broader organizational/mission perspective
- Builds the case for change & articulates costs & risks for not making change
- Monitors & assesses internal & external environment for trends & practices
- Sponsors clinical pathway development, implementation, & evaluation
- Ensures compliance w/ UM standards & requirements in the continuum
- Develops strategies for determining the most cost-effective & efficient levels of continuing patient care clinically & operationally
- Establishes appropriate mechanisms to collect & analyze data on care delivered outside of the KP integrated system
- Provides oversight to the data & reporting systems used to track the performance of continuing care operations
- Works collaboratively w/ medical group & labor leadership to recommend service delivery changes or internalization of services where appropriate
- Works w/ regional continuing care leadership to establish appropriate case management programs to monitor & manage the care of members in non-KFH facilities
- Achieves key LMP initiatives & ensures the demonstration of LMP behaviors
- Assures short & long-range financial goals are met by establishing & controlling continuing care expenses in support of the overall financial plan
- Manages the Health Plan function in ensuring implementation of new deductible plan products w/in the local areas
- Ensures the integration of quality, service, & efficiency improvements into day-to-day operations
- Develops, coaches, & manages a staff dedicated to providing expertise & customer service
Qualifications:
Basic Qualifications:
- Extensive experience, typically over ten (10) years in clinical & managerial roles in a multi-faceted health care system & multi-service provider setting required
- Bachelor's degree in health services or business administration, public health, nursing or related discipline required
- Master's degree in one of the aforementioned fields preferred
- Current valid California RN license strongly preferred
- Success in meeting/exceeding performance expectations
- Expertise in project management, problem solving, verbal & written communication, & collaborative working skills
- Ability to lead & manage through influence & change
- Knowledge of quality assurance, resource management, health plan regulatory, & licensing processes including federal & state laws & regulations such as: Knox-Keene Act, Federal HMO Act, Public Employees Medical & Hospital Act, The Joint Commission, & all applicable Medicare & Medical regulations
- Ability to function collaboratively in a multi-entity partnership environment
- Ability to manage various stakeholder interests & demonstrated skills in facilitation, problem solving, decision-making, persuasion, & team-orientation
- Must be able to work in Labor/Management Partnership environment
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.