Description: 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.

Primary Location: California,Pasadena,Walnut Center - Regional Offices
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 08:00 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Flexible
Employee Status: Regular
Employee Group/Union Affiliation: NUE-SCAL-01|NUE|Non Union Employee
Job Level: Director/Senior Director
Department: Regional Offices - Pasadena - Rgnl Hosp Admn-Utilizatn Mgmt - 0801
Pay Range: $187600 - $242770 / year The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted.
Travel: Yes, 50 % of the Time
Flexible: Work location is on-site at a KP location, with the flexibility to work from home. Worker location must align with Kaiser Permanente's Authorized States policy. At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.

Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest

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