Director Care Coordinator/Case Management (Health Plan)

Company: Kaiser
Location: Ewa Beach
Posted on: March 17, 2023

Job Description:

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 area.
• 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 requirements.
• 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 members.
• Partner with leaders across the enterprise, on enterprise initiatives.
• Directs, staffs, and organizes the care coordination / case management.
• Continually evaluates and improves the quality of the care and services provided.
• 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:
  
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  Experience
  • Minimum five (5) years of nursing experience in a clinical setting required.
  • Minimum four (4) years of management experience in health plan/hospital/Case Management required.
    
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    Education
    • Bachelors degree in nursing, healthcare or business-related field.
    • Graduate of an accredited school of nursing.
      
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      License, Certification, Registration
      • 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
          
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          Additional Requirements:
          • 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 regulations.
          • 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.
            
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            Preferred Qualifications:
            • Masters degree in nursing, healthcare or business-related field.
            • Case Management Certification.
              
              
              Job Schedule:
              Job Category: Nursing Licensed & Nurse Practitioners

Keywords: Kaiser, Honolulu , Director Care Coordinator/Case Management (Health Plan), Executive , Ewa Beach, Hawaii