Director of Regional Care Management

HealthCare Partners Medical Group is a multispecialty medical group that is recognized for its quality of care and high rates of patient satisfaction. HealthCare Partners has over 3,500 employees, including 500+ primary care and specialty physicians, caring for more than 500,000 patients throughout Los Angeles County and Northern Orange County. HCP operates 40 medical clinics, five urgent care centers, two medical spas, and an ambulatory surgery center. If you're looking to make a difference with a large, financially stable, well-recognized, privately-owned Medical Group.

HealthCare Partners may be the employer for you. We are currently seeking a Diretcor of Regional Care Management for our South Bay Region.

 

Responsibilities will include:
* Overseeing management and optimization of all CQI, UM and CM activities as it relates to inpatient and ambulatory health care delivery programs within their accountable region. 
* Managing regional managers and other staff directly responsible for the day-to day operations of care management programs. 
* Participating in the development, implementation and maintenance of all programs to ensure that patient care maximizes quality and continuity by utilization of appropriate resources and appropriate alternatives to inpatient care within the parameters of health plan benefits and established contracts. 
* Accountability when part of the Regional Accountable Team, for the clinical, quality, financial and patient satisfaction outcomes of the region.
* Identifying and participating in the development and implementation of CM and UM policies and procedures.
* Ensuring compliance throughout the region and consistency throughout the network.
* Closely monitoring and analyzing all inpatient and outpatient reports; identifying trends and making  recommendations to the regional team regarding interventions to improve resource management.
* Developing and coordinating strategies for ensuring the delivery of care in the most appropriate setting.
* Assuring that contracted providers are used; collaborating with Contracting Department to obtain new contracts for specialty and ancillary services.
* Monitoring all high risk/high utilizing patients in regard to care delivery, referrals, contracting, etc.
* Monitoring provider referral patterns for appropriate utilization of specialty and ancillary services.
* Initiating organizational and system changes to improve departmental efficiency and effectiveness with respect to staffing; improving the outcome of care management programs within the region.
* Providing supervision, guidance and mentoring to managers and staff reporting to this position.
* Working cooperatively with the Regional Team and other VP/Directors of Care Management.
* Coordinating or performing projects/activities as delegated by the organizational committees and the Lead Vice

* President, Care Management.
* Participating and supporting organizational committees as appropriate, including Regional Care Management

* Committee per regulatory guidelines.
* Identifying, developing and overseeing the educational needs of care management staff, providers and other areas indicated.
* Identifying opportunities for the development of new care management approaches, including processing of referrals and preparation of proposals with cost analysis, IS requirements, education and implementation plan to be presented to the centralized team for network-wide implementation.
*Developing and managing regional business plan and budget along with the Regional Accountable Team.
* Motivating and leading the CM staff in setting and reaching goals for continuous improvement.
* Working collaboratively with other Vice Presidents/Directors of CM to ensure that appropriate processes are in place to maintain compliance with regulatory bodies.
Setting a professional example and being a role model by exemplifying the vision and values of HealthCare Partners Medical Group.
* Assuming other responsibilities as delegated by the Lead Vice President, CM, and/or other members of the regional management team. 
* Performing all responsibilities outlined above for region with membership over 40,000.

 

Experience - External:

Required:
Current and active California RN license.
Bachelors degree from a four year college.
Five years management experience in a medical group/IPA or HMO setting.
Previous responsibility for LOS, Disease Management, Referral oversight,and Bed Day management.
Experience in creation and implementation of outcome measures of new programs.
Previous fiscal/budgetary accountability.
Computer proficiency.


PREFERRED:
An advanced degree in health administration, public health, nursing administration or related area.