Vice President, Reg Care Management

Overview:

Responsiblefor the oversight, management and optimization of all CQI, UM and CareManagement activities as they relate to inpatient, social service, home health,DME and other healthcare delivery programs within Healthcare Partners MedicalGroup. Participates in the development,implementation and maintenance of all programs to ensure that patient caremaximizes quality and continuity by utilization of appropriate resources andalternatives to inpatient care within the parameters of health plan benefitsand established contracts. Ensuresconsistency and standardization of the application of these healthcare deliveryprograms across the regions, and the integration of these programs within theIPA model. Works with other members ofthe Regional Accountable Team (RAT) to ensure the clinical, quality, financialand patient satisfaction outcomes of the region. Works closely with all members of RAT as wellas Health Enhancement, Quality Improvement, Contracting and the Office of the MedicalDirector.

Essential Functions:

• Consistently exhibits behavior and communicationskills that demonstrate HealthCare Partners (HCP) commitment to superiorcustomer service, including quality, care and concern with each and everyinternal and external customer.
• Identifies need for and participates in thedevelopment and implementation of care management and utilization managementpolicies and procedures, and ensures compliance throughout the region andconsistency throughout the network.
• Monitors closely and analyzes all inpatient andoutpatient reports and identifies trends. Makes recommendations to the Regional Accountable Team (RAT) regardinginterventions to improve all resource management.
• Develops and coordinates strategies for ensuringthe delivery of care in the most appropriate setting.
• Ensures that contracted providers are used and collaborateswith Contracting department to obtain new contracts with preferred providersbased upon specific quality and utilization criteria.
• Monitors of all high-risk/high-cost patients inregard to care delivery, referrals, contracting, etc. Oversees cross-regionalhigh-cost areas of Care Management (i.e., transplant or high-volume complexlines of business such as IPA/group).
• Monitors provider referral patterns for appropriateutilization of specialty and ancillary services.
• Initiates organizational and system changes toimprove departmental staffing efficiency and effectiveness, and care managementprogram outcomes within the region.
• Coordinates or performs projects/activities asdelegated by organizational committees and Supervisor.
• Participates and supports organizational committeesas appropriate including the Regional Care Management Committees per regulatoryguidelines.
• Identifies, develops and oversees the educationalneeds of the Care Management providers and staff including the implementationof an extensive orientation program, cross-training and proactive approach toCare management.
• Identifies opportunities for the development of newcare management approaches and prepares proposals with cost analysis, ISrequirements, educational needs and implementation plan to be presented to thecentralized team for network-wide implementation.
• Develops and manages regional business plans and budgetwith RAT.
• Motivates and leads the Care Management staff insetting and reaching goals for continuous improvement in quality, service andcost-effective care to all HCP customers.
• Uses, protects, and discloses HCP patientsprotected health information (PHI) only in accordance with Health InsurancePortability and Accountability Act (HIPAA) standards.
• Performs additional duties as assigned.

EDUCATION:

• Bachelor s degree from a four-year college and/or aprofessional certification requiring formal education beyond a two-year college.
• Current California RN license.
• Master s degree preferred.
• Degree in Nursing, Healthcare Administration orrelated field preferred.

EXPERIENCE:

• Over 5 years and up to and including 7 years ofexperience
• 5 years of management experience in a medicalgroup, IPA or HMO setting.
• Experience in the creation and implementation ofoutcome measures of new programs.

KNOWLEDGE, SKILLS, ABILITIES:

• Computer literate.
• Proficient in Microsoft Office applications.
• Demonstrated effective management abilities.
• Excellent verbal and written communication skills.
• Ability to work cooperatively with peers andsubordinates.
• Ability to act professionally under pressure.
• Results-oriented.

DaVita Medical Group manages and operates medical groups and affiliated physician networks in California, Colorado, Florida, Nevada, New Mexico, Pennsylvania and Washington. A leading independent medical group in America, DaVita Medical Group has over two decades of experience providing coordinated, outcomes-based medical care in a cost-effective manner. As of December 31, 2016, DaVita Medical Group s teammates, employed clinicians and affiliated clinicians provided care for approximately 1.7 million patients. DaVita Medical Group s leadership development initiatives and social responsibility efforts have been recognized by Fortune, Modern Healthcare, Newsweek and WorldBlu.

DaVita Medical Group is an equal opportunity/affirmative action employer. As such, DaVita Medical Group makes hiring decisions solely on the basis of qualifications and experience, and without regard to age, race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.

We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks.

DaVita Medical Group will consider qualified applicants who have criminal histories in a manner consistent with the law.

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