Description: Job Summary:
Provides leadership and direction for Complex Care Management in multiple delivery systems. Is responsible to understand the application health insurance regulations and benefits. Is responsible to meet or exceed financial, service quality and clinical quality outcome goals established for the department and enterprise. Provides human resources management and assurance of compliance with regulatory and practice standards. Plans, promotes and implements quality assurance and quality improvement programs to enhance Care Management. Provides quality, consumer centered services by partnering with multiple disciplines, division leadership and KFHPW leadership
Essential Responsibilities:

Leads, manages and develops staff to ensure the best use of human resources and to achieve financial, service and clinical quality outcomes. Recruits, hires, promotes, monitors, disciplines and terminates staff when necessary. Completes and presents performance evaluations. Mentors and coaches staff to meet or exceed cost, quality, service and staff satisfaction outcomes. Builds teams and develops individuals to effectively problem solve, resolve conflict and demonstrate appropriate team behavior.
Participates in the planning, implementation, evaluation and continual improvement of services to respond to customer expectations and meet KFHPW goals and objectives. Problem solves and develops systems to meet external and internal customer expectations with multiple family practice clinics, specialty clinics and other KFHPW-wide services including home health, behavioral health, pharmacy, lab, and radiology in both a Contracted provider and Staff model setting. Applies content and system expertise to leverage services in a collaborative setting within the KFHPW delivery system and external delivery system. Supports KFHPW and division/district level service delivery planning. In collaboration with Care Management leadership team, identifies strategies to ensure all Care Management programs and services meet the financial, service and clinical quality standards.
Promotes the delivery of Complex Care Management services across the continuum to include patient assessment, planning, intervention and evaluation through the development of systems and tools that promote communication and exchange of information between care settings. Assures information systems and applications support key work and meet regulatory requirements.
Plans, identifies outcomes and implements quality assurance and quality improvement plans. Ensures all staff meet clinical quality and technical and customer service standards. In collaboration with Care Management leadership, identifies and develops standards of clinical care and clinical protocols. Tracks, trends and monitors outcome standards related to Care Management goals and implements improvement strategies to ensure optimal health care goals for consumers with complex care management needs.
Develops budget strategies. Makes decisions related to resource allocation and priorities. Develops and implements efficient and effective operational processes and methods. Sets standards and targets to ensure fiscal resources are managed within budgetary allocation. Effectively and efficiently utilizes fiscal resources to stay within budget allocation including developing processes that optimize skill and licensure levels. Identifies and participates in the development of ongoing orientation, educational and training programs for the department. Identifies and develops individual learning plans as needed in the areas of clinical quality and service quality. Participates in the orientation and training of staff. Identifies and mentors staff through coaching and motivational interviewing techniques to reach their performance agreement outcomes.
Basic Qualifications:
Experience

Minimum two (2) years of utilization management or care management environment experience.
Minimum two (2) years of staff management experience.
Minimum five (5) years of clinical experience.

Education

Bachelors degree in nursing or a healthcare administration related field.

License, Certification, Registration

Registered Nurse License (Washington) required at hire OR Compact License: Registered Nurse required at hire

Additional Requirements:

Working knowledge of care provided in multiple clinical settings and case management.
Knowledge or experience with Lean principals and change management.
Excellent staff management skills.
Working knowledge of budget management.
Strong communication, analytic and computer skills with working knowledge of Microsoft Office programs.
Expertise in population-based improvement and management.
Skilled in accelerated clinical practice improvement; Knowledge of KFHPW Clinical information systems.
Experience in change management, lean process and implementation of work plans.

Preferred Qualifications:

Five (5) years of staff management and current experience in CM leadership role with focus on population-based, chronic disease management.
Masters degree in nursing or a healthcare administration related field.
History of measurable success in program implementation and oversight.