Executive Director, Care Coordination

This position has primary accountability for developing and implementing the Care Without Delay philosophy, strategic goals, and objectives for the care management/care coordination/utilization management functions across settings of care that meet clinical, financial, and regulatory requirements of the markets. This position also provides leadership, oversight, and coordination of care across hospitals and post-acute settings and partners with ambulatory care coordination and care programs including Medicare, Medi-Caid, and NCQA required programs to address the holistic needs of our members and ensure they are getting the right care, at the right place, and at the right time. This position consistently supports compliance and the Principles of Responsibility (Kaiser Permanentes Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to the applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanentes policies and procedures.
This position is responsible for leading the market strategy, planning, and execution of a patient centered and integrated approach to care coordination and resource stewardship across the continuum of care.
This position will provide executive leadership and oversight for the development of a comprehensive care coordination and resource stewardship strategy work.
Provides leadership to health plan and medical group providers in the development of regional strategies to coordinate and plan the provision of health care services across the continuum of care for patients with complex needs.
Creates the structure and processes to identify populations with complex needs and to develop, implement and evaluate programs, policies, and standards for continuum of care services that develop coordinated plans of treatment and delivery systems to provide excellent service to those members with complex needs.
In collaboration with internal and external leaders/stakeholders develop, implement, and promote an integrated strategy and operational plan for care coordination and case management within and across hospital, post-acute and skilled nursing facility settings to improve, facilitate and streamline the care delivery process, the patient and provider experience to improve quality, cost, and experience.
Identifies and institutes performance improvement efforts based on evidence-based research, practices, and patient outcomes.
Understands the finances of various care settings, contributes ideas, and plans for efficient stewardship of resources appropriately.
Partners with health plan and medical group leaders to ensure optimize care coordination across care setting, programs and the continuum.
Ensure compliance with all applicable care coordination and case management regulatory and accreditation guidelines such as Medicare, DHCS/Medicaid, Department of Managed Healthcare (DMHC), The Joint Commission (TJC), and National Committee for Quality Assurance (NCQA) regulatory requirements, as appropriate.
Actively supports Executive Resource Steering Committee and co- chairs or contributes to regional/market or enterprise committees and workgroups.
Recruits and develops high performing and highly engaged leaders, including a talent pipeline.
Minimum eight (8) years of substantial experience progressive operational experience in clinical and leadership roles in a multi-faceted health care system and multi-provider settings
Bachelors degree in Nursing, Health Services Business Administration, Public Health/Administration or related field.
License, Certification, Registration
Extensive experience within the continuum, including but not limited to hospital, skilled/ post-acute, ambulatory, care coordination, and resource stewardship operations Strong understanding of data analytics, healthcare, population health, medical delivery, and medical management; Demonstrated knowledge and experience with Medicare and Medicaid managed care, NCQA, TJC and other regulatory requirements Successful experience managing a broad range of financial and or