Vice President,Reg Care Mgmt

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Company: DaVita Medical Group
Location: El Segundo, CA 90245

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OVERVIEW OF POSITION:

Responsible for the oversight, management and optimization of all CQI, UM and Care Management activities as they relate to inpatient, social service, home health, DME and other healthcare delivery programs within Healthcare Partners Medical Group. Participates in the development, implementation and maintenance of all programs to ensure that patient care maximizes quality and continuity by utilization of appropriate resources and alternatives to inpatient care within the parameters of health plan benefits and established contracts. Ensures consistency and standardization of the application of these healthcare delivery programs across the regions, and the integration of these programs within the IPA model. Works with other members of the Regional Accountable Team (RAT) to ensure the clinical, quality, financial and patient satisfaction outcomes of the region. Works closely with all members of RAT as well as Health Enhancement, Quality Improvement, Contracting and the Office of the Medical Director.


ESSENTIAL FUNCTIONS:

  • Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners’ (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
  • Identifies need for and participates in the development and implementation of care management and utilization management policies and procedures, and ensures compliance throughout the region and consistency throughout the network.
  • Monitors closely and analyzes all inpatient and outpatient reports and identifies trends. Makes recommendations to the Regional Accountable Team (RAT) regarding interventions to improve all resource management.
  • Develops and coordinates strategies for ensuring the delivery of care in the most appropriate setting.
  • Ensures that contracted providers are used and collaborates with Contracting department to obtain new contracts with preferred providers based upon specific quality and utilization criteria.
  • Monitors of all high-risk/high-cost patients in regard to care delivery, referrals, contracting, etc. Oversees cross-regional high-cost areas of Care Management (i.e., transplant or high-volume complex lines of business such as IPA/group).
  • Monitors provider referral patterns for appropriate utilization of specialty and ancillary services.
  • Initiates organizational and system changes to improve departmental staffing efficiency and effectiveness, and care management program outcomes within the region.
  • Coordinates or performs projects/activities as delegated by organizational committees and Supervisor.
  • Participates and supports organizational committees as appropriate including the Regional Care Management Committees per regulatory guidelines.
  • Identifies, develops and oversees the educational needs of the Care Management providers and staff including the implementation of an extensive orientation program, cross-training and proactive approach to Care management.
  • Identifies opportunities for the development of new care management approaches and prepares proposals with cost analysis, IS requirements, educational needs and implementation plan to be presented to the centralized team for network-wide implementation.
  • Develops and manages regional business plans and budget with RAT.
  • Motivates and leads the Care Management staff in setting and reaching goals for continuous improvement in quality, service and cost-effective care to all HCP customers.
  • Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
  • Performs additional duties as assigned.


EDUCATION:

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


    EXPERIENCE:

  • Over 5 years and up to and including 7 years of experience
  • 5 years of management experience in a medical group, IPA or HMO setting.
  • Experience in the creation and implementation of outcome 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 and subordinates.
  • Ability to act professionally under pressure.
  • Results-oriented.

What’s the first thing that happens when one of the leading independent medical groups in the country comes together with a global leader in health care? Opportunity. With DaVita Medical Group, HealthCare Partners, The Everett Clinic, Northwest Physicians Network, MountainView Medical Group and Magan Medical Clinic joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. We’re changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life’s best work.(SM)


Careers with OptumCare. Here’s the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world’s large accumulation of health – related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. OptumCare, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you’ll find incredible ideas in one incredible company and a singular opportunity to do your life’s best work.(SM)

Diversity creates a healthier atmosphere: OptumCare and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. OptumCare and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.