Job Summary:
The Manager of Post-Acute Care provides leadership and operational oversite for care provided to the member within a focused area of the Continuum of Care. Areas of responsibilities programs responsibilities include skilled nursing, home health, hospice referrals, acute rehabilitation and LTACH any may include others as needed. Primarily responsible for the daily management of operations, staffing, and utilization management functions for focus areas of accountability. Supports the Director of Post-Acute Care with the management and integration of operational support services within their accountable area. This role requires close coordination with all facets of the organization, including TSPMG, Health Plan Services Administration, network providers and partners, partner hospitals/ facilities, community care partners, marketing, and human resources and labor representation.

Essential Responsibilities:

• Provides operational leadership and executes the strategic direction and makes recommendations over areas of accountability. Manages and is responsible for all skilled nursing, home health, hospice acute rehabilitation, and LTACH care coordination and utilization management functions. Other areas may be assigned. Establishes and achieves long-range strategic plans, goals and objectives for this focused area of the continuum of care. Defines and communicates strategic objectives and scope to staff and strategic partners.


• Achieves performance expectations for their focused area areas of continuum of care resource management operations. Establishes standards of practice and monitoring of performance for continuum of care operations for the area of accountability including skilled nursing patient day rate (PDR), skilled nursing and home health readmission rates, and access.


• Develops and implements all components of Utilization Management, Care Coordination and ensures compliance with NCQA, State, Federal and other regulatory accreditation standards for focused area.


• Ensures consistency of process and program objectives across geographic areas, agencies and for focused area by focusing team efforts in achieving a coherent, integrated whole. Supports the structure and processes, policies and standards for focused area of accountability to support continuum of care services delivery to improve quality, service and affordability/cost trends.


• Partners with the Director of Post-Acute Care and TSPMG and other Health Plan departments to execute tactical strategies for focused area of Continuing Care Services.


• Coordinates with facility-based and regional resource management leadership to develop systems to ensure the seamless transition of patients to the continuum for focused area.


• Develops and manages budget performance and executes appropriate strategies to manage cost and improve quality of care for focused area.


• Develops strategic partnerships with external providers to improve access and capacity for our members, quality, service, access and affordability/cost trends in continuum of care services for focused area.


• Member of Continuum Management team and may be involved in other key initiatives such as TCO, TRICARE, NCQA, Thrive Local and others as needed.


• Leads efforts to improve the health of KPGA employees and physicians, working with Human Resources and others.


• Preforms other related duties as assigned.

Basic Qualifications:
Experience

• Minimum ten (10) years experience in health care with in-depth knowledge of inpatient and post-acute, delivery system operations through both core and network providers, strategic planning, and overall service delivery.

Education

• Bachelors Degree in nursing or related field OR four (4) years of experience in a directly related field.


• High School Diploma or General Education Development (GED) required.

License, Certification, Registration

• N/A

Additional Requirements:

• Demonstrated strong interpersonal/communication skills.


• Strong presentation, leadership, project management and consultative and problem-solving skills required.


• Ability to lead and manage through influence and change.


• Demonstrated ability to lead professionals through influence and collaboration.


• Understanding of and experience in process improvement and the tools and data requirements for supporting an effective process improvement practice.


• Must exhibit efficiency, collaboration, candor, openness and results orientation.


• Strong verbal and written communication skills and presentation skills required.


• Decisiveness, action-orientation, personal integrity, capability to persevere in difficult situations and a focus on strategic leadership issues highly desired.


• Understand & shown execution in Regulatory environment (NCQA, TRICARE & Medicare).


• Possess an open collaborative leadership style that promotes teamwork and partnership while achieving desired results.


• Thorough knowledge of quality assurance, resource management, health plan regulatory and licensing processes including federal and state laws and regulations.

Preferred Qualifications:

• Experience working in a high-level administrative capacity within multi-faceted health care system and multi-service provider setting preferred.


• Understanding of the operations of KP preferred.


• RN license in appropriate jurisdiction(s) preferred.


• Current Georgia license required in any of the following clinical professions: Registered Nurse, Pharmacist, Clinical Social Worker, Physical Therapist, Occupational Therapist, Speech Therapist or Dietitian preferred.


• Masters Degree in health care, business or two (2) years of experience in a directly related field.

Notes:

• Weekend on-call rotation. Excellent interpersonal and communication skills.


• Maintain current and establish new vendor partnerships.

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