This position has responsibility for ensuring quality care and appropriate services are provided to KP members experiencing Continuing Care Services and the implementation of Care Without Delay across the Market, ensuring effective, service-oriented, and efficient care. This position is responsible to establish strategic direction and a system view to support the Market’s provision of the continuum of care services: Home Health, Advanced Care at Home, Hospice, Palliative Care, Acute Rehab Services, Dialysis/ESRD network management and services for members, EPRP, SNF, Medical Transportation/Ambulance Services, Outside Medical Services and Referrals, DME, and Utilization Management. This position will provide regional oversight and monitoring of the planning and implementation of continuum and community capacity management and strategic resource planning. This position deploys measurement systems, operational processes, goals, and investments to effectively improve the performance of the Market. The executive will effectively collaborate with Market area leaders, PMG, National Office staff, other Markets within KP, community providers, KP contracting, and labor partners to improve the quality of care and service that we provide to our members and our communities.
Essential Responsibilities:
Provide executive level leadership, strategic direction and drives performance over areas of accountability.
Identify and implement actions in areas of accountability to improve quality, service, financial performance, and contractual compliance.
Supports the structure and evidence-based practices to develop, implement and assure success of all areas related to the Continuum of Care and Care Without Delay, ensuring alignment with KP standards and an enterprise approach.
Directs other activities as assigned that improve care to our members and the communities we serve.
Ensures that Kaiser Permanente (KP) is strategically positioned in the Market to maintain ongoing regulatory compliance across the continuum of care, including NCQA accreditation, Medicare 5 Star compliance, DPH and CMS care delivery compliance.
Develops and manages the payroll, non -payroll, and capital budgets and expenditures for assigned areas.
Identifying future demand by levels of care; including community resource capacity.
Utilization Management: Lead the implementation of UM plans and agreements with KP hospitals and Core contracted/partner hospitals and non-core hospitals.
Champions, implements, and shares continuum of care delivery innovations with other Markets to achieve organizational goals.
Explores critical issues related to the Continuum of Care and Care for specific populations, such as complex needs patients; implementing evidence-based care delivery models to address those needs.
In partnership with key constituents across KP, develops and implements the future vision for care across the continuum and as a progressive community health partner.
Basic Qualifications:
Experience
Minimum ten (10) years of experience in a senior leadership capacity (such as administrator, service line leader, or functional leader) with accountabilities in the following areas: hospital operations, administrative clinical management, post-acute operations, and health plan operations.
Education
Bachelors degree in a nursing, business, or related clinical field.
License, Certification, Registration
Registered Nurse License (Virginia) OR Pharmacist Doctorate License (Maryland) OR Licensed Social Worker (District of Columbia) OR Licensed Clinical Social Worker (Virginia) OR Pharmacist Doctorate License (Virginia) OR Pharmacist Doctorate License (District of Columbia) OR Registered Nurse License (District of Columbia) OR Licensed Clinical Social Worker - Certified (Maryland) OR Pharmacist License (Maryland) OR Pharmacist License (District of Columbia) OR Pharmacist License (Virginia) OR Registered Nurse License (Maryland) OR Licensed Certified Social Worker (Maryland)
Additional Requirements:
N/A
Preferred Qualifications:
Masters degree in a clinical field such as nursing strongly preferred.