Description : Job Summary :
Responsible for the overall design, care model, coordination, management, evaluation, and continuous quality improvement of the care coordination / case management and care transition programs for the KP Washington region.
Programs include but are not limited to : Emergency Patient Resources and Options (EPRO), Care Transitions, Referral Coordination, Urgent Care and Emergency Department Case Management, and Medical Transportation.
Essential Responsibilities :
- Provides direction and expertise to KP WASHINGTON care coordination / case management, care transition programs, and related services.
- Lead a department with frontline staff providing care coordination / case management to members across the region.
- Provides oversight and integration of overall operations (Washington, human resources, and competency) for all programs.
- Assists the VP of Care and Utilization Management in providing strategic leadership to ensure efficient utilization of resources and the delivery of quality, cost effective, efficient health care to meet established goals, objectives, policies, and regulatory requirements.
- Monitors and assesses trends and best practices in care coordination, complex case management, care transitions, and makes recommendations to develop / adjust strategies, programs, and service delivery to meet changing business and market conditions.
- Partners with continuum leaders to ensure seamless transition of members.
- Partners with leaders across the enterprise-on-enterprise initiatives
- Directs, staffs and organizes the care coordination / case management and care transition programs across the region. Continually evaluates and improves the quality of the care and services provided.
- Designs, plans, and implements an effective, efficient, and quality model of care to provide for the needs of members, physicians, and personnel.
- Establishes appropriate program goals and objectives and related metrics to measure the effectiveness of the program.
- Develops, monitors, and controls payroll, non-payroll and capital budgets and expenditures for all programs.
- Monitors operational and financial reports and implements improvement plans as required.
- Ensures the development and implementation of care coordination / case management and care transition policies and procedures.
- Ensures ongoing education and competence measurement of care coordination / case management and care transition personnel.
- Makes hiring decisions, takes disciplinary action, and conducts performance assessments for assigned staff.
- Participates in committees and / or projects.
- Collaborates effectively with internal and external stakeholders to ensure the effectiveness and efficiency of the programs.
- Performs other duties as assigned.
Basic Qualifications :
Experience
- Minimum five (5) years of clinical experience required.
- Minimum four (4) years of management experience in health plan / hospital / Case Management required.
Education
Bachelors degree in nursing or healthcare or business-related field.
License, Certification, Registration
Licensed Independent Clinical Social Worker (Washington) OR Registered Nurse License (Washington)
Additional Requirements :
- Knowledge and expertise in case management scope of practice, technique and community resources.
- Demonstrated knowledge of case management, discharge planning, transition of care, transfer coordination; NCQA,
- Skilled collaborator and team builder.
- Ability in planning, organizing, conflict resolution, negotiating and interpersonal skills.
- Knowledge regarding compliance requirements by the various regulatory agencies and various legislative directives affecting health care management and reimbursement.
- Excellent communication skills, good problem-solving skills, and decision-making skills; PC skills to include Microsoft word, excel, power point, and electronic medical record.
- Strong customer service orientation required.
- Must be able to work in a Labor / Management Partnership environment.
Preferred Qualifications :
- Masters degree in nursing, healthcare or business-related field.
- Case Management Certification.
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