Sr. Director, Continuum of Care – Health System
South San Francisco, CA
Sr. Director | Administrator, Continuum of Care – Health System – South San Francisco
(CA RN desired- may consider others)
*** Need someone who has overseen large scope in home health, hospice, SNF, utilization.
Highly visible senior leadership role will have partner with the administrators of two large medical groups. Sr Director is responsible for performance expectations for all areas of continuing care operations, including Home Health/Hospice, SNF, DME, Ambulance, Palliative Care, Social Services , Case Mgmt, Continuing Care Utilization Management, Revenue outside the hospital, Shared Continuing Care Services, Benefit Application, Contracts. Shared responsibility for Home Health and Hospice, DME, Ambulance, Utilization.
This leadership role is responsible for the development, planning, management and the integration and delivery of operational system processes and standards of practice, in alignment w/the organization’s mission, strategic business plan, and related performance improvement expectations.
- In collaboration w/local and Regional Leadership defines and communicates strategic objectives and scope. Articulates issues or problems from a broader organizational/mission perspective.
- Creates the structure and processes to develop, implement and evaluate programs, policies and standards for continuing care Services to ensure coordinated plans of treatment, delivery systems that meet member needs, and cost effective utilization of necessary Services.
- Ensures the integration of quality, service and efficiency improvements into day-to-day operations.
- Establishes appropriate methods to define, categorize, and monitor claims and referred Services. Provides oversight to the data and reporting systems used to track the performance of continuing care operations.
- Works collaboratively w/medical group and labor leadership to recommend service delivery changes or internalization of Services where appropriate.
- Works w/Regional continuing care leadership to establish appropriate case Mgmt programs to monitor and manage the care of members in outside facilities.
- Responsible for the efficient delivery of all continuing care Services for members by overseeing the development, negotiation, and utilization of cost-effective, high quality contracts w/outside providers.
- Monitors and assesses trends, external environment and internal practices; makes recommendations to develop/adjust strategy to meet the changing business and market conditions.
- Builds relationships w/local leadership and community partners to develop and meet utilization targets and related quality goals in the continuum.
- Works with leadership to target diseases/conditions such as Palliative Care, Behavioral Health, Elder Care that would benefit from a Regional multidisciplinary approach.
- Sponsors clinical pathway development, implementation and evaluation.
- Builds the case for change and articulates costs and risks for not making change. Champions new ways of meeting targets and/or goals. Explores critical issues not explicitly addressed by others. Anticipates and plans for future issues or problems.
- Recommends adjustments to operations to improve efficiency and to meet changing business needs.
- Minimum ten (10) years of experience in clinical and managerial roles in a multi-faceted health care system and multi-service provider setting required.
- Bachelor’s degree in health services or business administration, public health, nursing or related discipline required.
- Demonstrated success in meeting/exceeding performance expectations.
- Demonstrated expertise in project management, problem solving, verbal and written communication and collaborative working skills.
- Demonstrated ability to function collaboratively in a multi-entity partnership environment.
- Able to lead and manage through influence and change.
- Able to manage various stakeholder interests and demonstrated skills in facilitation, problem solving, decision making, persuasion and team-orientation.
- Thorough knowledge of quality assurance, resource management, health plan regulatory and licensing processes including federal and state laws and regulations such as: Knox-Keene Act, Federal HMO Act, Public Employees Medical and Hospital Act, The Joint Commission, and all applicable Medicare and Medi-Cal regulations.
- Master’s degree in one of the aforementioned fields preferred.
- Current valid California RN license strongly preferred.
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