Kaiser Permanente Manager (RN), Elder Care Program - Georgia Region in Atlanta, Georgia
Based on KPGA Regional Clinical Strategy and Annual Clinical Quality Goals, the Manager, Population Health is responsible for the development, implementation, supervision and evaluation of new and existing population health management programs and/or initiatives aimed to positively impact members' health status and/or ability to effectively self-manage their chronic condition(s). In alignment with this responsibility, the Manager, Population Health will: oversee administration, budgeting, supervision and all aspects of efficient delivery of departmental services and programs, including, but not limited to, metrics, both clinical and non-clinical, and staff productivity and efficiency, implement regional strategies to support HEDIS and Medicare Stars performance in collaboration with Health Plan, Medical Group, Quality and Operations strategies, ensure compliance with federal and state regulatory requirements including, but not limited to Chronic Care Improvement Program (CCIP), Quality Improvement Program (QIP), Quality Improvement Strategy (QIS), Special Needs Plan (SNP), and applicable NCQA accreditation standards, e.g. PHM. Creates and implements improvements initiatives that are in alignment with regional and national goals and objectives.
Oversees the operational and clinical functions of regional-based population health management programs/initiatives, specifically: Based on KPGA Regional Clinical Quality Strategy and in collaboration with the Director and physician partners, implements, supervises, and evaluates all administrative, operational, and clinical activities of population health management programs/initiatives and teams to support the KP national initiatives and the region's NCQA, HEDIS, and Medicare Stars Performance and close care gaps and improve quality of care and health outcomes; Co-leads process improvement work groups for populations supported by population health management programs/initiatives; Leverages opportunities for targeted outreach and partners with Pharmacy, Operations, Quality Resource Management, Primary Care, Behavioral Health as well as other appropriate departments to achieve regional quality goals; Provides oversight and guidance to assure compliance with National Committee for Quality Assurance (NCQA) and CMS standards for the KPGA region. Assesses and monitors program clinical performance by the establishment of program goals and targets, PRN and annually, and use of metrics reporting dashboard, including, but not limited to, clinical outcomes, utilization, and patient satisfaction; Tracks program goals, and clinical and financial benchmarks to demonstrate the impact population health management programs have on improving members health outcomes as well as assuring decreasing inappropriate utilization and costs. Responds to departmental RFPs regarding population health management programs, where applicable.
Oversees the management functions of regional-based population health management teams, specifically: Orients, trains, and supervises staff; leads hiring and termination processes; Establishes productivity levels for staff and teams, reviews productivity reports and takes suitable and timely actions to appropriately manage performance trends and provide feedback for growth and development. Ensures accurate documentation in accordance with new and existing workflows in and through appropriate and efficient/optimal use of clinical tools, including, but not limited to, KP Health Connect, CarePOINT, and Reporting WorkBench; Supervises and coaches' direct reports about job performance and professional development; Creates a working environment which is both challenging and rewarding that fosters teamwork and professionalism and enables a strong sense of contribution, influence and accomplishment.
Oversees departmental budget, specifically: Assists with budget planning and annual budget preparation; Monitors monthly payroll and non-payroll expenses; Provides variance explanations in a timely manner; Approves expenditures and provides explanations when needed; Other duties, as assigned.
Minimum five (5) years of experience in case management, utilization review, quality, healthcare project or program management. or population-based care .
Minimum three (3) years management/supervisory experience.
Bachelor's degree in nursing, public health, business, health education, OR four (4) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
Current Georgia RN license (required RN licensure from others states okay if intent to apply if outside the State of Georgia) OR other licensure commensurate with education or degree required.
Certified Professional in Healthcare Quality (CPHQ) or the ability to obtain certification within six (6) months of hire.
Certified Complex Case Manager (CCM) or the ability to obtain certification within twelve (12) months of hire, if applicable.
Training, working knowledge, and experience in continuous quality improvement activities.
Experience interpreting data, managing performance using data, and communicating results.
Experience working with physicians and other health care professionals.
Proficient computer skills, including MicroSoft Excel, Visio, and PowerPoint.
Well versed in contemporary strategies of population health management, case management, care coordination, especially chronic disease management, health behavior change models, and access to and use of preventive services.
Demonstrated ability to lead through influence and collaboration.
Familiarity with relevant NCQA standards and requirements for successful site visit experience.
Familiarity with federal and state regulatory requirements related to quality, e.g. Special Needs Plan (SNP), with federal and state regulatory requirements including, but not limited to Chronic Care Improvement Program (CCIP), Quality Improvement Program (QIP), Quality Improvement Strategy (QIS), Special Needs Plan (SNP).
Familiarity with HEDIS, CMS and other regulatory agencies.
Minimum seven (7) years of program and management/supervisory experience.
Master's degree in public health, health economics, healthcare administration or related field OR six (6) years of experience in a directly related field.
TITLE: Manager (RN), Elder Care Program - Georgia Region
LOCATION: Atlanta, Georgia
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.