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Regional Director of Care Coordination in the Continuum
2 months ago
Job Summary:
Responsible for providing strategic development/planning, oversight, implementation, coordination, and evaluation/improvement within the inpatient case management, post-acute case management, and /or affiliate hospital space. Supports the medical centers in the oversight, development, and implementation of seamless transitions across the continuum of care. This position works collaboratively with key stakeholders, including Hospital, Health Plan, Behavioral Health, Continuing Care Programs Leaders, SCPMG Medical Directors and Administrative Leaders, Inpatient, Ambulatory, Pharmacy, Post-Acute, Long Term Care and Continuing Care Programs, Contracting, Medi-Cal State Programs team, Revenue Cycle Leaders, legal and regulatory departments to achieve quality of care standards and outcomes and to align inpatient case management, post-acute case management, and /or affiliate hospital space with regional and organizational goals and objectives.
Essential Responsibilities:
In collaboration with SCPMG and KFHP/Hospitals Divisional and Service Area Leadership and Health Plan Physician Advisors, sets regionwide goals and priorities for inpatient case management, post-acute case management, and /or affiliate hospital programs.
Develops regional strategic initiatives and operational recommendations for implementation to meet the ongoing, new business, and market conditions as well as services needs across the delivery care system.
Responsible for the efficient delivery of continuing care services for KP members by leading and implementing initiatives across the care continuum.
Ensures alignment of goals and objectives, the spread of best practices and the efficient use of resources, in collaboration with other existing healthcare programs and services across the continuum (i.e. Ambulatory Care, Emergency and Inpatient Hospital Care, Behavioral Health Care, Post-acute and long term care, MediCal State Programs, Home Care, SNP, SPD, Palliative Care, Hospice Care, etc.) and with resources and services external to Kaiser Permanente.
Participates in the development, negotiation, and utilization of cost-effective, high quality local contracts with outside providers.
Identifies issues and implements corrective action.
Establishes partnerships with other Service Area leadership and Continuing Care Managers and leaders including but not limited to utilization management and long-term care for joint contracting opportunities.
Maintains systems and processes for effective quality and clinical outcomes management programs.
Ensures compliance in meeting all regulations and standards related to SND, Medicare, TJC, Title 22, and all other federal, state, and local requirements.
Coordinates with SCPMG/KFH/KPHP to provide for the seamless transition of patients from inpatient to improve integration and efficient transitions across the care continuum.
Monitors LTC financial performance and identifies and implements strategies to reduce costs and improve quality of service/care.
Tracks and assesses internal and external best practices which add value to overarching member care experience, quality, access, budget, and /or utilization across the inpatient case management, post-acute case management, and /or affiliate hospital programs
Identifies issues and implements corrective action.
Develops and implements quality and utilization standards across care continuum to guarantee seamless care and delivery of services in alignment to organizational strategies like affordability and cost effective utilization.
Develops, coaches, and manages a staff within scope of accountability to ensure consistent provision of high-quality clinical care/service.
Upholds Kaiser Permanentes Policies and Procedures, Principles of Responsibilities and applicable state, federal and local laws.
Performs other duties as assigned.
Basic Qualifications:
Experience
Minimum ten (10) years of clinical experience.
Minimum eight (8) years management/leadership experience, five (5) years of which in a long-term care and/or utilization management function.
Education
Masters Degree in health care or business-related field.
License, Certification, Registration
Registered Nurse License (California) required at hire
Additional Requirements:
Demonstrated ability to deliver and contract for health care service in continuing care setting.
Demonstrated ability to utilize communication, presentation, leadership, analytical and problem-solving skills.
Demonstrated ability to lead and manage through influence and change.
Knowledge of federal and state laws and regulations such as Knox-Keene Act, Federal HMO Act, Public Employees Medical and Hospital Act, TJC, and all applicable Medicare and Medi-Cal regulations.
Must be able to work in a Labor/Management Partnership environment.
Demonstrated knowledge of health care industry trends, developments, and issues.
Demonstrated ability to utilize oral and written communication skills and interpersonal skills such as influence, negotiation, persuasion, and conflict resolution.
Preferred Qualifications:
Case Management Certification.
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