Kaiser Permanente
Manager, Care Management (Remote / Virtual)
5 days agoPayCompetitive
LocationHillsboro/Oregon
Employment typeOther
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Job Description
- Req#: 1333437
- Use established channels of communication to share information, receive feedback and report problems. Facilitate the communication of plans and decisions to staff and providers to facilitate linkages and flow of information to others. Build credibility with physicians as a champion for patient transitions, quality, social work and care coordination professionalism. Effectively facilitates consensus building to accomplish goals and objectives. Provide constructive feedback and reports problems as well as positive comments. Builds and maintains an environment which recognizes and values differences in staff, physicians, patients and communities. Collaborate with social work and nursing programs to provide required resources. Routinely rounds on staff to communicate key messages and identifies concerns and issues. Routinely rounds on patients to gain feedback.
- Act as an expert resource for staff and utilizes knowledge in clinical area of practice. Direct supervision and evaluation of professional/staff practices, research and trends. Apply knowledge to the development of standards of care and practice to ensure optimal patient outcomes. Create, modify and evaluate policies and procedures. Maintain personal and professions growth of staff and others. Partner with medical staff and other disciplines to assist with establishment of patient care goals for department development. Evaluate department care delivery model and the needed staff or resources to provide safe, optimal care. Ensure safe, therapeutic environment, both for in the moment organizational support and long term. Ensure staff is educated on risk management and compliance issues and correct action is identified in areas of potential liability. Ensures staff support for expedited patient transitions by initiating escalations paths. Collaborate with all departments involved in transitions in care and/or community partners.
- Articulate the organizations performance improvement program and goals. Develop, implement and maintain quality/service monitoring processes. Key contributor in formulation of department goals which are reflective of measurable objectives and evidence-based practices. Maintain department compliance with all regulatory requirements. Monitor department quality/service programs with safety, environment, pharmacy and documentation issues. Support the quality/trainer role and facilitate the quality plan developed by the staff. Facilitate and seek resolution of customer complaints and facilitate improvement in processes or circumstances to improve the level of customer satisfaction. of measurable objectives and evidence-based practices. Maintain department compliance with all regulatory requirements. Monitor department quality/service programs with safety, environment, pharmacy and documentation issues. Support the quality/trainer role and facilitate the quality plan developed by the staff. Facilitate and seek resolution of customer complaints and facilitate improvement in processes or circumstances to improve the level of customer satisfaction.
- In collaboration with the Director, provide leadership and direction in accordance with the organization and departmental goals, objectives and behavioral standards of the organization. Perform performance evaluations and regular rounding with staff. Provide counseling, coaching, and monitoring of personnel. Perform/participate in in corrective action process. Facilitate inter-departmental relationships so that mission, vision, goals of department and organization are achieved. Demonstrate critical thinking and use of evidence-based practice. Support the Unit Based Teams (UBT) to accomplish tasks and goals. Actively participates/leads committees and task forces as needed. Ensures staff compliance with all mandatory classes and education. Facilitate a culture of creative thinking and act as a change agent to challenge the status quo. Responsible for own professional growth and supports work-life balance. Ensure staff has the knowledge and skills to provide appropriate, safe care to patients and families through education, coaching, training, teaching or experience. Work with outside vendors, agencies to assure coordination of services and represent the organization in a professional manner. Primarily responsible for managing Equal Employment Opportunity and other HR investigations for the department. Managing reporting of Company employee information, and manages employee relations training and assistance activities
- Develops and maintains regional Care Management written resources and standards of care, including procedures, clinical practice resources, nursing staff competencies. Works with physician advisors, business partners and colleagues for Care Management, Quality Assurance, utilization management, health systems and Electronic medical Record to maintain regional quality and appropriate resource utilization. Provides clinical oversight to staff in the department (professional and support staff) to ensure staff are at capacity and have resources available to ensure growth and development. Oversees orientation and development of curriculum. Defining and communicating professional practice.
- Collaborates with other department leaders in the development of department budget, providing input and evaluation of processes, equipment and make recommendations. Educate team members on financial implications of department operations. Drives towards achieving financial and operational targets.
- Participates in weekend and holiday call.
- Develops and maintains expert level of knowledge and skills related to availability of and criteria for regulatory requirements for utilization management and ordering of, brokering for, and assertive advocacy for the patient and family as well as the health care system in all matters of optimal use of health care resources. This includes acting on behalf of the member to ensure they are informed and understand their appeal rights and processes if they disagree with a health care determination. Ensuring efficient utilization of health care resources by: ensuring that the plan for an acute care stay for individual patients is well supported by MCG Criteria and understood by the patient, family and health care team, and that the plan is progressing effectively and efficiently toward resolution and transition to a lower level of care; by assuring that patient/family receive right care at the right time so that quality and utilization are simultaneously enhanced.
- Provides education and program development functions, including ensures systematic and ongoing contact with hospital staff/other Kaiser departments to share information regarding UM coordination role and ongoing responsibility for acute care/ED patients. Provides and facilitates educational support to assure health care employees providing direct care of patients with complex Medical Management/UM needs have the Medical Management/UM knowledge and skills required to provide the appropriate care to patients and families. Provides leadership in Medical Management/UM planning with hospital personnel to develop and implement policies and procedures related to patient care settings. Participates in professional committees/task forces as needed/requested. Ensures that regulatory and compliance standards are met in collaboration with others in the interdisciplinary healthcare team. Participates in quality and utilization management activities. Participates in continuing education to incorporate and maintain up to date knowledge and best practices in leading Medical Management/UM planning process.
- Assures compliance with Federal, State, CMS, NCQA, and other regulatory agencies and internal standards and requirements; including participation in audit activities as needed.
- Additional Essential Responsibilities if Mgr, Care Management for Regional Telephonic Medicine Center/Virtual Hospital (RTMC/VH)
- Responsible for operations supporting acute care UM to achieve business and organizational strategic objectives. Develops and implements business plans into tactical action items; ensuring all policies and procedures are followed; delegating tasks to meet goals and objectives; overseeing the completion of work assignments; aligning team efforts; building accountability for and measuring progress in achieving results; identifying and addressing improvement opportunities; removing obstacles that impact performance; and guiding performance and developing contingency plans accordingly.
- Facilitates utilization management for members care with non-KFH hospital facilities and providers. Identifies and reports risk management and quality of care issues.
- Assures compliance with Federal, State, NCQA, other regulatory agencies and internal standards and requirements; including participation in audit activities as needed.
- Annually research, reviews, and develops regional Acute Care UM policies, procedures, criteria and training programs based on current federal and state regulatory requirements and organizational needs. Develops training materials, education tactics, and programs that are based on adult learning principles and take into account the novice-to-expert framework of skill development and knowledge acquisition. Implements instructional and curriculum design skills (methodology selected is appropriate for topic etc.) and assists others in instructional design.
Job Summary:Responsible for managing daily department operations and provides support and assistance to the director and will be assigned distinct areas of focus within the department, such as quality/training, regional plan hospital staff management and KP hospital staff management. The manager under the supervision of the director holds direct administrative authority for the department. He/she is directly accountable to the director of the department. The manager is the primary resource for the staff. The manager facilitates work flow in the department and with ancillary, departments and outside services. Assure the provision of high quality, reputable and cost-effective services while meeting regulatory requirements through supervision and management of multidisciplinary professional and support staff (licensed and non-licensed). The manager assists with the management of the department personnel, provision of safe, cost effective, quality patient transitions, a safe work environment and the facilitation of educational activities for the staff. The manager has direct reports and supervision authority over those reports. The manager is responsible to ensure utilization management (UM) compliance.Essential Responsibilities:About the company
Providing high-quality, affordable health care services and improving the health of our members and the communities we serve.