CONTINUUM ADMINSTRATOR

CONTINUUM ADMINSTRATOR

This position supports Kaiser Permanente´s code of conduct and compliance by adhering to all laws and regulations, accreditation and Licensure requirements, and internal policies and procedures. Kaiser Permanente is proud to be an equal opportunity/affirmative action employer.

DEPARTMENT: Administration SCHEDULE: Full-Time Regular, 40hrs/wk, Day Shift, Monday-Friday, 8:30am to 5:00pm.
EDUCATION/CERTIFICATION/ LICENSE: Bachelor´s degree in Health Services or Business Administration, Public Health, Nursing or related discipline required. ´Current valid California RN license strongly preferred´

QUALIFICATIONS: Extensive experience, typically over ten years, in clinical and managerial roles in a multi-faceted health care system and multi-service provider setting required. Demonstrated success in meeting/exceeding performance expectations. Demonstrated expertise in project management, problem solving, verbal and written communication and collaborative working skills. Ability to lead and manage through influence and change. Thorough knowledge of quality assurance, resource management, health plan regulatory and licensing processes including federal and state laws and regulations such as: Knox-Keene Act, Federal HMO Act, Public Employees Medical and Hospital Act, The Joint Commission, and all applicable Medicare and Medi-Cal regulations. Demonstrated ability to function collaboratively in a multi-entity partnership environment. Must be able to work in labor/Management Partnership environment. Ability to manage various stakeholder interests and demonstrated skills in facilitation, problem solving, decision making, persuasion and team-orientation.

Preferred Qualifications: Master´s degree in one of the aforementioned fields preferred.

SKILLS TESTING: N/A

POSITION SUMMARY: Reporting to the Executive Director for the Continuum, with secondary accountability to Area Managers, this position is responsible for the development, planning, management, and the integration and delivery of KFH/HP operational system processes and standards of practice, in alignment with the organization´s mission, strategic business plan, and related performance improvement expectations.

DUTIES: In collaboration with Regional Continuum Administrators achieves/exceeds performance expectations for all areas of continuing care operations, including Home Health/Hospice, SNF, DME, Ambulance, Claims & Referrals, and Eldercare, Palliative Care, ESRD, Psych, Social Services, Case Management, Continuing Care UM, Revenue outside the hospital, Shared Continuing Care Services, H/HP Benefit Application, Contracts. Has joint responsibility for Home Health and Hospice, DME, Ambulance, Utilization Management, Social Services, and Contracts. Creates the structure and processes to develop, implement and evaluate programs, policies and standards for continuing care services to ensure coordinated plans of treatment, delivery systems that meet member needs, and cost-effective utilization of necessary services. In collaboration with local and regional Leadership defines and communicates strategic objectives and scope. Articulates issues or problems from a broader organizational/mission perspective. Builds the case for change and articulates costs and risks for not making change. Champions new ways of meeting targets and/or goals. Explores critical issues not explicitly addressed by others. Anticipates and plans for future issues or problems. Monitors and assesses internal and external environment for trends and practices. Recommends adjustments to operations to improve efficiency and to meet changing business needs. Ensures rapid transfer of best practices. Builds relationships with local leadership and community partners to develop and meet utilization targets and related quality goals in the continuum. Works with KFH/HP, TPMG and labor leaders to target diseases/conditions such as Palliative Care, Behavioral Health, and Elder Care that would benefit from a regional multidisciplinary approach. Sponsors clinical pathway development, implementation and evaluation. Ensures KFH/HP compliance with UM standards and requirements in the continuum. Coordinates with facility based leadership to develop systems to ensure the seamless transition of patients through different care settings. Where capacity or resource constraints exist, works with regional and local leadership to identify opportunities to coordinate contracting efforts for outside medical services. In conjunction with the Executive Director for the Continuum Process Team Leaders, develops strategies for determining the most cost-effective, efficient levels of continuing patient care clinically and operationally. In collaboration with finance, planning and analysis and patient business services, establishes appropriate mechanisms to collect and analyze data on care delivered outside of the KP integrated system. Establishes appropriate methods to define, categorize, and monitor claims and referred services. Provides oversight to the data and reporting systems used to track the performance of continuing care operations. Works collaboratively with medical group and labor leadership to recommend service delivery changes or internalization of services where appropriate. Works with regional continuing care leadership to establish appropriate case management programs to monitor and manage the care of members in non-KFH facilities. Ensures the successful operational implementation of HealthConnect continuing care functionality. Ensures the successful implementation of, promoting, and operationalizing the Labor-Management Partnership throughout the organization. Achieving key LMP initiatives and ensuring the demonstration of LMP behaviors throughout the organization. Ensuring Labor participation in appropriate decision making forums and committees. Responsible for the efficient delivery of all continuing care services for KP members by overseeing the development, negotiation, and utilization of cost-effective, high quality contracts with outside providers. Establishes joint contracting relationships across medical centers where appropriate. Assures short and long-range financial goals are met by establishing and controlling continuing care expenses in support of the overall financial plan. In collaboration with HPRS, establishes policies, procedures and protocols for the reimbursement of claims submitted by KP members for outside services to maximize reimbursement revenue from other insurers (e.g., Medicare or Medi-Cal) with consistent and appropriate interpretation and application of the health plan benefit. Manages the Health Plan function in ensuring implementation of new deductible plan products within the local areas. Ensures the integration of quality, service and efficiency improvements into day-to-day operations. Develops, coaches and manages a staff dedicated to providing expertise and customer service. Monitors and assesses trends, external environment and internal practices; makes recommendations to develop/adjust strategy to meet the changing business and market conditions. Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees. Consistently supports compliance and the Principles of Responsibility (KP´s code of conduct) by maintaining confidentiality, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable Federal and State laws and regulations, accreditation and licensure requirements, and KP policies and procedures.

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