Manager, Care at Home

Job Summary :

The Manager of Care at Home provides leadership and operational oversight for care provided to the member in their home setting within the Continuum of Care.

Areas of responsibility include home health, hospice, palliative care, and home infusion services. Primarily responsible for the daily management of operations, staffing, and utilization management functions for these areas of accountability.

Supports the Director of Care at Home with the management and integration of operational support services within their accountable area.

This role requires close coordination with all facets of the organization, including TSPMG, Health Plan Services Administration, network providers and partners, partner hospitals / facilities, community care partners, marketing, and human resources and labor representation.

Essential Responsibilities :

• Provides operational leadership and executes the strategic direction and makes recommendations over areas of accountability.
• Manages and is responsible for all home health, hospice, palliative care, and home infusion care coordination and utilization management functions.
• Other areas may be assigned.
• Establishes and achieves long-range strategic plans, goals, and objectives for this focused area of the continuum of care.
• Defines and communicates strategic objectives and scope to staff and strategic partners.
• Achieves performance expectations for their focused area of continuum of care resource management operations.
• Establishes standards of practice and monitoring of performance for continuum of care operations for the area of accountability including home health and hospice readmission rates, patient satisfaction, quality indicators, and access.
• Develops and implements all components of Utilization Management, Care Coordination and ensures compliance with NCQA, State, Federal and other regulatory accreditation standards for focused area.
• Ensures consistency of process and program objectives across geographic areas, agencies and for focused area by focusing team efforts in achieving a coherent, integrated whole.
• Supports the structure and processes, policies, and standards for focused area of accountability to support continuum of care services delivery to improve quality, service, and affordability / cost trends.
• Partners with the Director of Care at Home and TSPMG and other Health Plan departments to execute tactical strategies for focused area of Continuing Care Services.
• Coordinates with facility-based and regional resource management leadership to develop systems to ensure the seamless transition of patients to the continuum for focused area.
• Develops and manages budget performance and executes appropriate strategies to manage cost and improve quality of care for focused area.
• Develops strategic partnerships with external providers to improve access and capacity for our members, quality, service, access, and affordability / cost trends in continuum of care services for focused area.
• Member of Continuum Management team and may be involved in other key initiatives such as Strategy, NCQA, Thrive Local, and others as needed.
• Leads efforts to improve the health of KPGA employees and physicians, working with Human Resources and others.
• Performs other related duties as assigned.

Basic Qualifications :

Experience

Minimum five (5) years working experience in health care.

Education

Bachelors degree in nursing.

License, Certification, Registration

Registered Professional Nurse License (Georgia) required at hire

Additional Requirements :

• Demonstrated understanding of and competence in serving culturally diverse populations.
• Demonstrated understanding of utilization management concepts, practices, and criteria.
• Demonstrated advancement in progressive leadership.
• Demonstrated knowledge and skills in care at home operations, regulations, standards, and best practices.
• Demonstrated knowledge in Home Health and Case Management
• Understand & shown execution in Regulatory and Accreditation environment (NCQA, Medicare, etc.).
• Strong analytical, problem-solving, and decision-making skills.
• Excellent communication, presentation, and interpersonal skills.
• Ability to lead, motivate, and develop a diverse and high-performing team.
• Ability to collaborate and partner with internal and external stakeholders at all levels.
• Ability to manage multiple projects, priorities, and deadlines in a fast-paced and dynamic environment.
• Proficient in Microsoft Office applications and electronic health records.
• Ability to travel within the Region as needed.
• Must be able to work in a Labor / Management Partnership environment.

Preferred Qualifications :

• Experience in a high-level administrative capacity within multi-faceted health care system and multi-service provider setting preferred.
• Masters degree.
3 days ago