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.

Primary Location: Washington,Renton,Renton Administration - Rainier
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 07:30 AM
Working Hours End: 04:30 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Flexible
Employee Status: Regular
Employee Group/Union Affiliation: NUE-WA-04|NUE|Non Union Employee
Job Level: Director/Senior Director
Department: Renton Admin Glacier - Utilization Mgmt-Admin - 1130
Pay Range: $150600 - $194810 / 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, 25 % 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