Reporting to the Sr Director, Population Management and Integrated Care Coordination, the Manager Post-Acute and In-Home Care manages the end-to end post-acute processes of care for all members of KPCO. Post-Acute Care is an end-to-end post-acute offering that manages episodes of care in all post-acute settings. These services may begin prior to the patient's discharge from the hospital, or for elective surgical cases, and continue post discharge. The program identifies the likely best sites-of-care matched to the appropriate level of care for the patient upon hospital discharge, working to ensure the highest level of clinical quality while proactively managing length of stay (LOS) when a Long-Term Acute Hospital (LTACH), Skilled Nursing Facility (SNF), Institutional Rehab Facility (IRF) or transition to their home setting is needed. An overarching intent is to ensure the member/patient receives the care that is required to improve their overall health, while reducing the burden of illness and readmissions. Making sound business decisions that are generally guided by core values, mission and policies and procedures, the Manager of Post- Acute Care will have management responsibility for the implementation of the post- acute strategy and the oversight of clinical operations aligned with the Post-Acute Care (PAC) program. This position is responsible for evaluating needs in post-acute settings, execution of the PAC program operations and overall performance of the key value drivers of the program across all clients and lines of business. Responsibilities include the implementation and oversight of all programs addressed in the post-acute strategy and clinical operations plans including In-Home Care.
Essential Responsibilities:Provides direct management and oversight of the coordination, and implementation of all aspects and functions of the Post-Acute & In-Home program making sure to integrate requirements from the Quality and Risk Management programs, Regulatory oversite, and other programs ensuring the effective continuum of care. Builds a clinical infrastructure in conjunction with the Director, Integrated Care Coordination by educating staff and implementing MCG leading practice clinical guidelines across the continuum to improve the clinical quality of care, reduce practice variation and medical costs appropriately.Works in conjunction with the Program Directors of Population Health to develop and operationalize population health strategies within designated responsibilities.Works with the operation's leadership management team to establish priorities and goals for clinical operations within the Post-Acute and In-Home Care Programs.Collaborates with cross-functional stakeholders within health plan departments, Care Delivery Organization and Medical Group. Continues to develop and maintain an expert level of knowledge and skills regarding professional standards, accreditation or regulatory requirements and industry leading practices for all integrated care coordination functions. Ensures appropriate staffing model and training for all new initiatives while monitoring outcomes/performance for the PAC and In-Home Care Programs.Serves as an advocate for the patient and family as well as the health care system in all matters of optimal and appropriateness of use of health care resources.Critically analyzes post-acute care service line metrics and develops plans that ensure PAC activities are compliant with regulatory (CMS) and accreditation agency (URAC & NCQA) standards and guideline specific requirements, as appropriate.Provides oversight for meeting post-acute expectations/benchmarks, creating and achieving care goals and performance measures, and ensures alignment with the organization's standards for quality, productivity and cost effectiveness. Participates in internal and external audits of PAC activities and outcomes.
Experience Minimum five (5) years of management experience of programs and people in multi-faceted healthcare setting (e.g. health plan, ambulatory, hospital) demonstrating experience and skills associated with change management and performance improvement required. Minimum three (3) years of managing end-to-end post-acute care.
Education Bachelor of Science nursing degree required.
License, Certification, Registration Unencumbered Active Colorado or in a reciprocal Compact State Licensure as a Registered Nurse.
Additional Requirements: Demonstrated extensive knowledge of program design, business and clinical operations, management practices, principles, and trends, and organizational development trends and practices required. Strong skills in personal computer applications, database, and spreadsheet applications required. Exceptional interpersonal, verbal and written communication skills required to work with internal and external customers required.
Preferred Qualifications: Clinical operations experience in health plan with a focus on population management and integrated care coordination preferred.Masters or MBA in nursing, health care administration or related field. Chronic Care Management Certification at time of hire or completed within 24 months after hiring preferred. Certified Case Management Certification at time of hire or completed within 24 months after hiring preferred.