Facilitates the development, implementation, and continuous improvement of the PHSO Transitional Care and Post-Acute Care Management programs including standardized protocols, goals, and process and outcome measures that positively impact the quadruple aim of better member and physician experience, better health, and reduced costs.
Collaborates with PHSO leadership to develop an annual monitoring plan for the PHSO’s Transitional Care and Post-Acute care management teams.
Provides leadership, direction, project management, and direct oversight for continuum and alignment of, Transitional Care and Post-acute care management care continuum strategies for Mercy PHSO.
Manages employee human resource activities (i.e. Kronos, required education attendance, FMLA (Family Medical Leave Act), performance appraisals, etc.)
Accountable for the management of all PHSO Transitional Care and Post-acute care management team members and activities across the MercyOne Network.
Monitors staff productivity to ensure team members and department are meeting performance driven goals and holding care teams members accountable for performance on those goals.
Implements PHSO strategies and infrastructure necessary to effectively manage costs, utilization and quality associated with risk contracts in the areas of:
Implementation of PHSO standard care management care models
Implementation of PHSO standard staffing models
At the direction of PHSO leadership, provides strategic and operational leadership of the PHSO, Transitional Care and Post-acute care management team including the areas of:
CIN Performance Metrics (process and outcome)
Care Management across the entire care continuum
Data analytics
Compliance
Total cost of care management
Reaccreditation
Orients, trains, and provides ongoing staff education and development to elevate staff competency and quality of care and services to meet reaccreditation guidelines.
Determines staff qualifications and competencies required to provide quality of care and maintain departmental accreditations.
Completes performance plans and evaluations in a timely manner for team members.
Manages, hires, develops, and retains a high performing team to achieve PHSO goals and initiatives.
Engages with CIN Leadership on a routine basis for optimal performance under value/risk-based contracts.
Analyzes and interprets clinical, cost, and utilization data, to identify opportunities for improvement.
Develops and maintains the Mercy PHSO Transitional Care and Post-acute care management performance benchmarks. Identifies successes and opportunities for improvement.
Develops and routinely monitors key, Transitional Care and Post-acute care management metrics keeping all stakeholders informed of potential problems and/or opportunities.
Serves as an internal liaison for Mercy PHSO and Market Leadership related to the cute care management and post-acute care network of partnered providers service line.
Maintains ‘Subject Matter Expert’ status for Transitional Care and Post-acute care management, including regulatory requirements and changes, payment structure, quality reporting requirements, and performance.
Develops, implements, and periodically reviews all policies and procedures that guide and support the assigned services.
Works to implement Mercy One PHSO’s Transitional and Post-acute care management strategy which may include engaging inpatient and primary care provider, acute case management departments as well as SNFist care delivery services.
Convenes, sets structure, and leads a monthly meeting with all PHSO Acute and post-acute care management team members.
Participates as a member of the Mercy One PHSO and Post-acute care management leadership team and related governance structures.
Prepares business plans, proposals, special projects, and presentations as requested.
Collaborates with the PHSO Network Team in maintaining all program accreditations.
Responsible for the performance of the PHSO’s post-acute network service line of care workflows.
Maintains relationships with the PHSO’s post-acute network of partnered providers administrative and clinical leadership teams.
Supports and facilitates communication between the PHSO, its chapters, Acute, Transitional Care and Post-acute care management team members.
Coordinates services with advance practice practitioners for development of skilled nursing facility network.
Education: Bachelor's degree in nursing, Healthcare Administration, Social Work, or other related areas required; master's degree is strongly preferred.
Experience: Minimum of 3 to 5 years previous supervisory experience; 3+ years of healthcare experience with a proven record of accomplishment of value/risk-based contracts experience, Acute care management/ Discharge planning experience preferred.
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.