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 ACAH, DME program management 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, human resources and labor representation.

Essential Responsibilities :

• Provides operational leadership, executes the strategic direction and makes recommendations over areas of accountability.
• Manages and is responsible for ACAH population admissions / discharges, home infusion care coordination, utilization management functions, DME program oversight and other areas as 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.
• Develops strategic partnerships with external providers to improve access, quality, service and affordability within the continuum of care, with an emphasis on optimizing DME services.
• 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.
• Ensures compliance with NCQA, State, Federal and other regulatory accreditation standards for focused area.
• Ensures consistency of process and program objectives across geographic areas.
• Provides support for the structure, processes, policies, and standards within the designated area of accountability, ensuring the delivery of continuum of care services to enhance quality, service efficiency, and manage affordability and cost trends.
• Collaborates with the Director of Care at Home, TSPMG, and other Health Plan departments to implement tactical strategies within the designated area of Continuing Care Services.
• Works closely with facility-based and regional resource management leadership to develop systems that ensure a seamless transition of patients within the designated area of the continuum of care.
• 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 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

Education

License, Certification, Registration

Additional Requirements :

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 :

Masters degree.