Responsible for the strategic development/planning, implementation, coordination and evaluation/improvement of multiple Continuing Care programs services and functions across the Hawaii region and multiple agencies. May also include one or more of the following: Long Term Care (SNFs and Nursing Homes), Outside Medical Services, Authorizations and Referrals Management (ARM), Transportation, Case Management, Home Health, Hospice, Palliative Care, Social Services, and other services such as DME. Partners with other KFHP/H and Hawaii Permanente Medical Group (HPMG) leaders to develop and implement strategies, policies, programs and initiatives that support the delivery of high quality, cost effective community-based care programs. Initiates and develops new models of service to improve and integrate patient care with strategic organizational/business goals and objectives.
Essential Responsibilities:Oversees the operations of multiple Continuing Care programs services and functions across the Hawaii region and multiple agencies. May include one or more of the following: Long Term Care (SNFs and Nursing Homes), Outside Medical Services, Authorizations and Referrals Management (ARM), Case Management, Home Health, Hospice, Palliative Care, Social Services, and DME. Ensures the integration of quality service & efficiency improvements into day-to-day operations. Ensures units are compliant with federal, state and local regulatory requirements.Responsible for the efficient delivery of continuing care services for KP members by participating in the development and utilization of cost-effective, high quality local contracts with outside providers.Monitors and assesses trends, external environment and internal practices.Makes recommendations to develop/adjust strategy and services/programs to meet changing business and market conditions, as well as service needs.Establishes, implements, develops/maintains and evaluates/improves internal and external continuing care services/programs that provide a coordinated and integrated continuum of care across the delivery system and which add value and meet or exceed quality, utilization, access, patient care and budget standards, goals and objectives.Designs, evaluates and develops systems, processes and policies/procedures to continuously improve clinical/patient care performance measures and departmental administrative processes/functions.Develops and implements quality and utilization standards for continuing care services to ensure coordinated plans of treatment/delivery of services that meet member needs and achieve the cost-effective utilization of necessary services.Develops strategies for determining the most cost-effective, efficient levels of continuing patient care clinically and operationally.Coordinates with HPMG/KFH/KPHP to provide for the seamless transition of patients from inpatient to outpatient settings.Ensures policies, practices and procedures comply with administrative, legal and regulatory requirements of Health Plan contracts and governmental regulatory agencies and accrediting organizations.Collaborates with appropriate levels of management to develop the overall financial plan.Assures short and long-range financial goals are met by establishing and managing the department budget and managing financial performance to reduce costs.Develops, coaches and manages a staff dedicated to providing high quality clinical care/service.Hires, trains, supervises, counsels, disciplines, and terminates assigned staff as appropriate.
Experience Minimum eight (8) years in a leadership role in the managed care industry, including hospital strategy, and/or integrated care delivery systems. Minimum three (3) years of management, leading teams and/or work groups or related experience.
Education Master's degree in Nursing, Public, Business or Health Services Administration, or a health care related field OR six (6) years of experience in a directly related field.
License, Certification, Registration Valid Hawaii RN license (must meet education requirement(s) for Hawaii State licensure) upon date of hire. Current BLS for Healthcare Provider CPR or CPR/AED for the Professional Rescuer certification upon date of hire.
Additional Requirements: Demonstrated knowledge of delivery system operations, strategic planning, and overall service delivery. Demonstrated ability to determine the key business issues and develops appropriate action plans from multidisciplinary perspectives. Proficient in team building, group interaction, conflict resolution, project management and budget management. Demonstrated experience in process improvement in a health care setting. Must be able to work in a Labor Management partnership environment.
Preferred Qualifications: Experience in leading initiatives with diverse stakeholders Experience in community health/benefits initiatives