Provides leadership and direction for NHS services as well as the day to day operations and fiscal management of NHS provided to members requiring sub-acute and long-term care. Is responsible to understand the application health insurance regulations and benefits. Is responsible to meet or exceed financial, service quality & clinical quality outcome goals established for the department and enterprise. Provides human resources management and assurance of compliance with regulatory & practice standards.
Plans, promotes and implements quality assurance & quality improvement programs to enhance NHS as it relates to our members care and transitions of care. In partnership with the NHS leadership team provides oversight for SNF facility performance to ensure overall safety, cost, quality and service for patients receiving sub-acute and long-term care. Coordinates Enterprise wide care management functions with other divisions and the health plan to optimize the patient experience, care coordination and ensure regulatory standards. Works collaboratively with division leaders to include GPD leadership and Health Plan leadership to ensure the achievement of care continuum and care management goals.
- Leads, manages and develops staff to ensure the best use of human resources and to achieve financial, service and clinical quality outcomes. Recruits, hires, promotes, monitors, disciplines and terminates staff when necessary. Completes & presents performance evaluations. Mentors & coaches staff to meet or exceed cost, quality, service and staff satisfaction outcomes. Builds teams & develops individuals to effectively problem solve, resolve conflict and demonstrate appropriate team behavior.
- Participates in the planning, implementation, evaluation and continual improvement of services to respond to customer expectations and meet KFHPW goals and objectives. Problem solves & develops systems to meet external & internal customer expectations with multiple family practice clinics, specialty clinics & other KFHPW -wide services including home health, behavioral health, pharmacy, lab, and radiology in both a Contracted provider and Staff model setting. Applies content and system expertise to leverage services in a collaborative setting within the KFHPW delivery system and external delivery system. Supports KFHPW and division/district level service delivery planning. In collaboration with Care Management leadership team, identifies strategies to ensure all Care Management programs and services meet the financial, service and clinical quality standards.
- Care Management/Contract Management: Ensure effective Enterprise wide contract management for skilled nursing facilities in conjunction with provider contracting. Ensures contracted SNF facility performance through the development of metrics to measure cost, quality and service within the facility in conjunction with the health plan, leads operational oversight for all SNF Care Management programs including supervision and hiring of staff, problem resolution and implementation of strategic care management programs. Coordinates with the health plan and across the GPD to ensure care management strategies align with Enterprise wide care management goals. Ensures all care management activities meet State/Federal and other regulatory governing body requirements and industry standards. Works collaboratively with division leaders to include GPD leadership and Health Plan leadership to ensure the achievement of care continuum and care management goals.
- Strategic Planning: In partnership with the Senior Director of Continuing Care and other members of the leadership team: Define targets for and lead development of strategies to achieve top level performance in safety quality, care experience, affordability and access for patients require sub-acute and long term care. Ensure that the organizational and delivery system vision and strategic direction are aligned with Care Delivery Division and Health Plan division goals and are communicated to the front line staff. Translates the impact of state and national sub-acute and long-term care management issues to KFHPW health Plan and Care Delivery Division leadership.
- Develops budget strategies. Makes decisions related to resource allocation and priorities. Develops and implements efficient and effective operational processes and methods. Sets standards and targets to ensure fiscal resources are managed within budgetary allocation. Effectively and efficiently utilizes fiscal resources to stay within budget allocation including developing processes that optimize skill and licensure levels. Identifies & participates in the development of ongoing orientation, educational & training programs for the department. Identifies & develops individual learning plans as needed in the areas of clinical quality and service quality. Participates in the orientation and training of staff. Identifies and mentors staff through coaching and motivational interviewing techniques to reach their performance agreement outcomes.
- Minimum three (3) years of health services management.
- Minimum two (2) years of staff management experience.
- Bachelor's degree in nursing or a health care administration related field.
License, Certification, Registration
- Current Washington State RN license at date of hire/transfer.
- Working knowledge of care provided in multiple clinical settings and case management.
- Knowledge or experience with Lean principals and change management.
- Excellent staff management skills.
- Working knowledge of budget management.
- Strong communication, analytic and computer skills with working knowledge of Microsoft Office programs.
- Expertise in population-based improvement and management.
- Skilled in accelerated clinical practice improvement; Knowledge of KFHPW Clinical information systems.
- Experience in change management, lean process and implementation of work plans.
- Five (5) years of staff management with focus on population-based, chronic disease management; History of measurable success in program implementation and oversight.
- Master's degree in nursing or a health care administration related field.