Director Care Coordinator/Case Management (Health Plan)
Posted on: November 26, 2022
Responsible for the overall design, care delivery model,
coordination, management, evaluation, survey readiness and
continuous quality improvement of the commercial, federal- and
state-mandated care coordination / case management for the KP HI
Service Area.Essential Responsibilities:
- Provides direction and expertise to all KP HI care coordination
/ case management, and related services, to include Centers for
Medicare and Medicaid Services (CMS) Coordinated Care Initiative,
CMS Special Needs Plan, and Medi-Cal programs.
- Lead a department with 20+ frontline staff providing care
coordination / case management to members across the service
- Provides oversight and integration of overall operations
(fiscal, human resources, and competency) for all programs.
- Assists the Asst Admin, Continuum of Care in providing
strategic leadership to ensure efficient utilization of resources
and the delivery of quality, cost effective, efficient health care
to meet established goals, objectives, policies, and regulatory
- Monitors and assesses trends and best practices in care
coordination, complex case management, and makes recommendations to
develop/adjust strategies, programs, and service delivery to meet
changing business and market conditions.
- Partner with continuum leaders to ensure seamless transition of
- Partner with leaders across the enterprise, on enterprise
- Directs, staffs, and organizes the care coordination / case
- Continually evaluates and improves the quality of the care and
- Designs, plans, and implements an effective, efficient, and
quality model of care to provide for the needs of members,
physicians, and personnel.
- Establishes appropriate program goals and objectives and
related metrics to measure the effectiveness of the program.
- Develops, monitors, and controls payroll, non-payroll and
capital budgets and expenditures for all programs.
- Monitors operational and financial reports and implements
improvement plans as required.
- Ensures the development and implementation of care coordination
/ case management policies and procedures.
- Ensures and oversees ongoing education and competence
measurement of care coordination / case management personnel.
- Hires, fires, takes disciplinary action, and conducts
performance assessments for assigned staff.
- Participates in committees and/or projects.
- Collaborates effectively with internal and external
stakeholders to ensure the effectiveness and efficiency of the
programs.Basic Qualifications: -Experience
- Minimum five (5) years of nursing experience in a clinical
- Minimum four (4) years of management experience in health
plan/hospital/Case Management required. -Education
- Bachelors degree in nursing, healthcare or business-related
- Graduate of an accredited school of nursing. -License,
- BLS/AED for Professional Rescuers OR Cardio Pulmonary
Resuscitation OR Basic Life Support within 1 months of hire
- Registered Nurse License (Hawaii) within 1 months of hire
- Knowledge and expertise in case management scope of practice,
technique and community resources.
- Strong conformability with KPHC and the implementation of new
modules within KPHC.
- Demonstrated knowledge of case management, discharge planning,
transition of care, transfer coordination; Medicare, Medicaid,
Title 22, NCQA, JCAHO, URAC, and other federal/state/local
- Skilled collaborator and team builder.
- Ability in planning, organizing, conflict resolution,
negotiating and interpersonal skills.
- Knowledge regarding compliance requirements by the various
regulatory agencies and various legislative directives affecting
health care management and reimbursement.
- Excellent communication skills, good problem-solving skills,
and decision-making skills; PC skills to include Microsoft word,
excel, power point, and electronic medical record.
- Strong customer service orientation required.
- Must be able to work in a Labor/Management Partnership
environment. -Preferred Qualifications:
- Masters degree in nursing, healthcare or business-related
- Case Management Certification.Job Schedule: Job Category:
Nursing Licensed & Nurse Practitioners
Keywords: Kaiser, Honolulu , Director Care Coordinator/Case Management (Health Plan), Executive , Honolulu, Hawaii
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