Director, Regional Care Manager inpatient-RN

Job Summary :

Responsible for the Care Coordination, Utilization Management RNs, Social Workers and / or support staff in the NW Region. The primary function is to oversee the daily operations of the Care Management Department over a multi-hospital system. Assists the Senior Director to implement the strategic plan and in the development of the Care Management program by driving advancements and innovations in transitions of care. Mentor, supervise and evaluate a team of coordinators, social workers and other assigned staff. Collaborate with multiple departments throughout the region. Regularly monitor and assess operations. Establish budget, policy and procedure. Establish standardization of Care Management and by collaborating with peer regional managers. Partners with plan hospital leadership to ensure mutual goals are achieved. Holds significant accountability for the overall success of the organization by ensuring outcome metrics are attained. Includes oversight of nursing professional practice standards, KP standards of care and clinical competency of staff in accordance with licensure and regulatory requirements; may also perform patient care to the extent necessary to maintain clinical expertise and competency to fulfill job responsibilities. Oversight of social work professional practice standards, KP standards of care and clinical competency of staff are managed by a dotted-line reporting relationship to social work-licensed administrators.

Essential Responsibilities :

• Provide leadership, oversight and direction of the daily care management operations, including high quality, cost effective delivery of patient care, managing licensed clinical personnel, delegating as appropriate, organizing and setting protocols and educating staff at multiple locations. Requires understanding of contracts, ability to negotiate with non-Kaiser entities and work with plan hospital management teams.
• Responsible for the successful implementation of agreed upon care management strategies that result in safe, cost effective, efficient, equitable, and patient-centered care. High accountability for meeting agreed upon metrics of success. Collaborate with the Care Management team, Medical Director, Senior Director, hospital and physician leadership to implement the care management model for the NW Region. Effectively facilitates consensus building to accomplish goals and objectives. Works with Continuum partners and Ambulatory Services to implement the best workflow practices to measure and improve the triple aim (cost, quality and patient experience). Assesses plans, implements, coordinates, monitors and evaluates all care and communication options with the goal of optimizing the patients care across the continuum. Evaluates patient care delivery model and the needed staff, equipment, and resources to provide safe, optimal care. In collaboration with VP Patient Care Services / Regional CNE and through dotted line reporting to nursing leadership provides clinical leadership and oversight of staff in the provision of nursing and other clinical services through nursing professional practice standards and Kaiser Permanente standards of care. Implements, supervises and maintains clinical practice and quality management standards, staff competencies and on-going development in accordance with regulations and accreditation requirements; ensures patient safety at point of care.
• Participates, develops, and submits budget to Senior Director for final approval. Educates team members on financial implications of operations. Manages within authorized budget and maintains ongoing process of identifying, evaluating, and implementing overall cost effectiveness of the department.
• Articulates the organizations performance expectations. Develops, implements and maintains quality monitoring processes. Maintains compliance with all regulatory requirements. Formulates department goals, audits, reports results, and develops action plans for improvement.
• Recruits, selects, retains, coaches, mentors and counsels personnel. Facilitates inter-departmental relationships so that mission, vision, goals of department and organization are achieved. Demonstrates critical thinking and use of evidence-based practice. Completes performance evaluations timely. Regular on site rounding with staff. Provides constructive feedback and effectively manages conflict. Unit Based Team, UBT sponsor who helps develop and support the UBTto accomplish tasks and goals for represented employees.
• Establish and maintain Utilization Management processes and ongoing outcome measures to ensure compliance and maximize billing workflow. Understands healthcare insurance with a high degree of knowledge of Medicare, Medicaid, commercial and other lines of business. Has fiduciary responsibility for patient day rate, length of stay, readmission rate and other important metrics that have significant impact on the financial performance of the organization.

Basic Qualifications :

Experience

Education

License, Certification, Registration

Additional Requirements :

Demonstrate extensive knowledge of process improveme