Manager, Care Management (Remote / Virtual)
Primary Location Hillsboro, Oregon
Worker Location Remote
Job Number 1333437 Date posted 01/24/2025
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Description:
Job Summary:
Responsible for managing daily department operations and provides support and assistance to the director and will be assigned distinct areas of focus within the department, such as quality/training, regional plan hospital staff management and KP hospital staff management. The manager under the supervision of the director holds direct administrative authority for the department. He/she is directly accountable to the director of the department. The manager is the primary resource for the staff. The manager facilitates work flow in the department and with ancillary, departments and outside services. Assure the provision of high quality, reputable and cost-effective services while meeting regulatory requirements through supervision and management of multidisciplinary professional and support staff (licensed and non-licensed). The manager assists with the management of the department personnel, provision of safe, cost effective, quality patient transitions, a safe work environment and the facilitation of educational activities for the staff. The manager has direct reports and supervision authority over those reports. The manager is responsible to ensure utilization management (UM) compliance.
Essential Responsibilities:
- Use established channels of communication to share information, receive feedback and report problems. Facilitate the communication of plans and decisions to staff and providers to facilitate linkages and flow of information to others. Build credibility with physicians as a champion for patient transitions, quality, social work and care coordination professionalism. Effectively facilitates consensus building to accomplish goals and objectives. Provide constructive feedback and reports problems as well as positive comments. Builds and maintains an environment which recognizes and values differences in staff, physicians, patients and communities. Collaborate with social work and nursing programs to provide required resources. Routinely rounds on staff to communicate key messages and identifies concerns and issues. Routinely rounds on patients to gain feedback.
- Act as an expert resource for staff and utilizes knowledge in clinical area of practice. Direct supervision and evaluation of professional/staff practices, research and trends. Apply knowledge to the development of standards of care and practice to ensure optimal patient outcomes. Create, modify and evaluate policies and procedures. Maintain personal and professions growth of staff and others. Partner with medical staff and other disciplines to assist with establishment of patient care goals for department development. Evaluate department care delivery model and the needed staff or resources to provide safe, optimal care. Ensure safe, therapeutic environment, both for in the moment organizational support and long term. Ensure staff is educated on risk management and compliance issues and correct action is identified in areas of potential liability. Ensures staff support for expedited patient transitions by initiating escalations paths. Collaborate with all departments involved in transitions in care and/or community partners.
- Articulate the organizations performance improvement program and goals. Develop, implement and maintain quality/service monitoring processes. Key contributor in formulation of department goals which are reflective of measurable objectives and evidence-based practices. Maintain department compliance with all regulatory requirements. Monitor department quality/service programs with safety, environment, pharmacy and documentation issues. Support the quality/trainer role and facilitate the quality plan developed by the staff. Facilitate and seek resolution of customer complaints and facilitate improvement in processes or circumstances to improve the level of customer satisfaction. of measurable objectives and evidence-based practices. Maintain department compliance with all regulatory requirements. Monitor department quality/service programs with safety, environment, pharmacy and documentation issues. Support the quality/trainer role and facilitate the quality plan developed by the staff. Facilitate and seek resolution of customer complaints and facilitate improvement in processes or circumstances to improve the level of customer satisfaction.
- In collaboration with the Director, provide leadership and direction in accordance with the organization and departmental goals, objectives and behavioral standards of the organization. Perform performance evaluations and regular rounding with staff. Provide counseling, coaching, and monitoring of personnel. Perform/participate in in corrective action process. Facilitate inter-departmental relationships so that mission, vision, goals of department and organization are achieved. Demonstrate critical thinking and use of evidence-based practice. Support the Unit Based Teams (UBT) to accomplish tasks and goals. Actively participates/leads committees and task forces as needed. Ensures staff compliance with all mandatory classes and education. Facilitate a culture of creative thinking and act as a change agent to challenge the status quo. Responsible for own professional growth and supports work-life balance. Ensure staff has the knowledge and skills to provide appropriate, safe care to patients and families through education, coaching, training, teaching or experience. Work with outside vendors, agencies to assure coordination of services and represent the organization in a professional manner. Primarily responsible for managing Equal Employment Opportunity and other HR investigations for the department. Managing reporting of Company employee information, and manages employee relations training and assistance activities
- Develops and maintains regional Care Management written resources and standards of care, including procedures, clinical practice resources, nursing staff competencies. Works with physician advisors, business partners and colleagues for Care Management, Quality Assurance, utilization management, health systems and Electronic medical Record to maintain regional quality and appropriate resource utilization. Provides clinical oversight to staff in the department (professional and support staff) to ensure staff are at capacity and have resources available to ensure growth and development. Oversees orientation and development of curriculum. Defining and communicating professional practice.
- Collaborates with other department leaders in the development of department budget, providing input and evaluation of processes, equipment and make recommendations. Educate team members on financial implications of department operations. Drives towards achieving financial and operational targets.
- Participates in weekend and holiday call.
- Develops and maintains expert level of knowledge and skills related to availability of and criteria for regulatory requirements for utilization management and ordering of, brokering for, and assertive advocacy for the patient and family as well as the health care system in all matters of optimal use of health care resources. This includes acting on behalf of the member to ensure they are informed and understand their appeal rights and processes if they disagree with a health care determination. Ensuring efficient utilization of health care resources by: ensuring that the plan for an acute care stay for individual patients is well supported by MCG Criteria and understood by the patient, family and health care team, and that the plan is progressing effectively and efficiently toward resolution and transition to a lower level of care; by assuring that patient/family receive right care at the right time so that quality and utilization are simultaneously enhanced.
- Provides education and program development functions, including ensures systematic and ongoing contact with hospital staff/other Kaiser departments to share information regarding UM coordination role and ongoing responsibility for acute care/ED patients. Provides and facilitates educational support to assure health care employees providing direct care of patients with complex Medical Management/UM needs have the Medical Management/UM knowledge and skills required to provide the appropriate care to patients and families. Provides leadership in Medical Management/UM planning with hospital personnel to develop and implement policies and procedures related to patient care settings. Participates in professional committees/task forces as needed/requested. Ensures that regulatory and compliance standards are met in collaboration with others in the interdisciplinary healthcare team. Participates in quality and utilization management activities. Participates in continuing education to incorporate and maintain up to date knowledge and best practices in leading Medical Management/UM planning process.
- Assures compliance with Federal, State, CMS, NCQA, and other regulatory agencies and internal standards and requirements; including participation in audit activities as needed.
- Additional Essential Responsibilities if Mgr, Care Management for Regional Telephonic Medicine Center/Virtual Hospital (RTMC/VH)
- Responsible for operations supporting acute care UM to achieve business and organizational strategic objectives. Develops and implements business plans into tactical action items; ensuring all policies and procedures are followed; delegating tasks to meet goals and objectives; overseeing the completion of work assignments; aligning team efforts; building accountability for and measuring progress in achieving results; identifying and addressing improvement opportunities; removing obstacles that impact performance; and guiding performance and developing contingency plans accordingly.
- Facilitates utilization management for members care with non-KFH hospital facilities and providers. Identifies and reports risk management and quality of care issues.
- Assures compliance with Federal, State, NCQA, other regulatory agencies and internal standards and requirements; including participation in audit activities as needed.
- Annually research, reviews, and develops regional Acute Care UM policies, procedures, criteria and training programs based on current federal and state regulatory requirements and organizational needs. Develops training materials, education tactics, and programs that are based on adult learning principles and take into account the novice-to-expert framework of skill development and knowledge acquisition. Implements instructional and curriculum design skills (methodology selected is appropriate for topic etc.) and assists others in instructional design.
Basic Qualifications:
Experience
- Minimum five (5) years of clinical experience as RN
- Minimum three (3) years of direct experience in hospital or healthcare services field.
- Minimum two (2) years of demonstrated knowledge in area of clinical care management.
- Minimum three (3) years of management experience as a director, manager, supervisor or other leadership role, such as lead or program/project management experience or related consulting experience where responsibilities would include managing teams of people, timelines, budget, etc.
Education
- Bachelors degree or higher in Nursing
License, Certification, Registration
- This job requires credentials from multiple states. Credentials from the primary work state are required at hire. Additional Credentials from the secondary work state(s) are required post hire.
- Registered Nurse License (Washington) within 3 months of hire OR Compact License: Registered Nurse within 3 months of hire
- Registered Nurse License (Oregon) within 3 months of hire
- Basic Life Support within 24 months of hire
Additional Requirements:
- Demonstrated extensive knowledge of process improvement techniques, and be able to facilitate complex group interactions within a sophisticated audience.
- Demonstrated leadership skills and understanding of core leadership concepts.
- Demonstrated subject matter expert in care management
- Demonstrated effective program management skills.
- Demonstrated effective analytical and problem solving skills.
- Ability to adapt to constantly changing priorities and managing a wide range of projects
- Must exhibit efficiency, collaboration, candor, openness and results orientation.
Preferred Qualifications:
- Minimum five (5) years of supervisory and management experience
- Experience working with interdisciplinary teams including but not limited to social work, rehabilitation services, nursing leadership, etc.
Masters degree in Nursing
- Nurse Practice Act, Joint Commission, Labor Law, all related and affiliate contracts, workers compensation, policies and procedures, human resource policies and procedures, OSHA, CMS, Health Department, Employee benefits, National labor relations board, standards of practice of professional organizations.
- Demonstrated ability to determine key issues and develop appropriate action plans from multidisciplinary perspectives.
- Demonstrated ability to lead professionals and manage others through influence and collaboration
- Demonstrated ability to conduct and interpret quantitative/qualitative information with analytical problem solving and guidance.
- Utilization management experience with MCG or InterQual Care Guidelines software
- Must be able to work in a Labor/Management Partnership environment
- Knowledge of community resources
- Working knowledge of the managed care industry
- Working knowledge of federal and state healthcare regulation and policy.
- Able to work autonomously
- Operational knowledge of computerized clinical documentation and office application systems including use of laptop/notebook computers.
- Demonstrates customer-focused service skills
- High level communication skills which allow for collaborative and timely interactions with clinicians, managers, staff, members and community partners.
Primary Location: Oregon,Hillsboro,Tanasbourne Regional Contact Center
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Sun, Mon, Tue, Wed, Thu, Fri, Sat
Working Hours Start: 08:00 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Remote
Employee Status: Regular
Employee Group/Union Affiliation: NUE-NW-01|NUE|Non Union Employee
Job Level: Manager with Direct Reports
Department: HILLSBORO REGIONAL CONTACT CTR - Appointment/Reception - 1008
Pay Range: $131600 - $170280 / year
Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data and a candidate's years of relevant work experience, education, certifications, skills, and geographic location.
Travel: No
Remote: Work location is the remote workplace (from home) within KP authorized states.
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
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
