Kaiser Permanente Regional Continuum Administrator, Hospice Care in Oakland, California
Reporting to the Executive Director for the Continuum, this position is responsible for the development, planning, management, and the integration and delivery of KFH/HP operational system processes and standards of practice, in alignment with the organization's mission, strategic business plan, and related performance improvement expectations. This position has joint or primary accountability for directing and coordinating all home or hospice care services across the region.
Primary accountabilities include direct oversight and reporting of Home Health or Hospice Service Directors, budget development, regulatory compliance, contract provider oversight, standardization of systems and outcomes among agencies, ensuring efficiencies within agencies, and performance Improvement. Joint accountabilities include Member services, utilization and financial management, site-specific policies/procedures, negotiating budget allocations, Human Resources/resolution of labor issues, Public Affairs, Environmental Services, Materials management, and infection control.
Creates the structure and processes to develop, implement and evaluate programs, policies and standards for home or hospice care services to ensure coordinated plans of treatment, delivery systems that meet member needs, and cost effective utilization of necessary services.
In collaboration with all Northern California Continuum Administrators, achieves/exceeds performance expectations for home or hospice care services, ensuring consistency and collaboration with other organizational objectives and initiatives. Case Management, Continuing Care UM, Revenue outside the hospital, Shared Continuing Care Services, H/HP Benefit Application, Contracts.
In collaboration with local and regional Leadership defines and communicates strategic objectives and scope. Articulates issues or problems from a broader organizational/mission perspective. 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. Monitors and assesses internal and external environment for trends and practices. Recommends adjustments to operations to improve efficiency and to meet changing business needs.
Builds relationships with local leadership and community partners to develop and meet utilization targets and related quality goals in the continuum. Establishes standards of practice and implementing monitors and performance for operations. Ensures consistency of process and program objectives across Northern California agencies and functional units by focusing team efforts in achieving a coherent, integrated whole.
Builds the case for change and articulating costs and risks for not making change.
Develops systems and approaches that will integrate member health planning and care delivery with TPMG and medical centers in ways that ensure the provision of the appropriate type and level of services in a timely, seamless fashion.
Develops strong collaborative relationships with KFH/HP, TPMG and labor leadership to achieve regional goals.
In collaboration with HPRS, establishes policies, procedures and protocols for the reimbursement of claims to maximize reimbursement revenue from other insurers (e.g., Medicare or Medi-Cal) with consistent and appropriate interpretation and application of the health plan benefit.
Works with KFH/HP, TPMG and labor leaders 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.
Ensures KFH/HP compliance with UM standards and requirements in the continuum. Coordinates with facility based leadership to develop systems to ensure the seamless transition of patients to and from home or hospice Care. Where capacity or resource constraints exist, works with regional and local leadership to identify opportunities to coordinate contracting efforts for outside home Ccre or hospice services . In conjunction with the Executive Director for the Continuum, develops strategies for determining the most cost-effective, efficient levels of patient care both clinically and operationally.
In collaboration with finance, planning and analysis and patient business services, established appropriate mechanisms to collect and analyze data on care delivered outside of the KP integrated system. 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 with medical group and labor leadership to recommend service delivery changes or internalization of services where appropriate.
Responsible for the efficient delivery of home or hospice care services for KP members by overseeing the development, negotiation, and utilization of cost-effective, high quality contracts with outside providers as required.
Establishes joint contracting relationships across medical centers where appropriate. . Ensures the integration of quality, service and efficiency improvements into day-to-day operations.
Assures short and long-range financial goals are met by establishing and controlling home or hospice care expenses in support of the overall financial plan.
Ensures rapid transfer of best practices. Collaborates with the Area Management team and the Area Manager to develop the overall finance plan.
Monitors and assesses trends, external environment and internal practices; makes recommendations to develop/adjust strategy to meet the changing business and market conditions.
Develops, coaches and manages a staff dedicated to providing expertise and customer service.
Ensures the successful operational implementation of HealthConnect as it relates to home or hospice care.
Ensures the successful implementation of, promoting, and operationalizing the Labor-Management Partnership throughout the organization. Achieving key LMP initiatives and ensuring the demonstration of LMP behaviors throughout the organization. Ensuring Labor participation in appropriate decision making forums and committees.
Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees.
Minimum ten (10) years of experience in clinical and managerial roles in a multi-faceted health care system and multi-service provider setting required.
Minimum ten (10) years of experience in home or hospice care.
Master's degree in health care, public administration, or related field OR two(2) years of experience in a directly related field.
Bachelors Degree in health care, public administration, or related field.
License, Certification, Registration
Demonstrated success in meeting/exceeding performance expectations.
Demonstrated expertise in project management, problem solving, verbal and written communication and collaborative working skills.
Ability to lead and manage through influence and change.
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.
Demonstrated ability to function collaboratively in a multi-entity partnership environment.
Requires ability to manage various stakeholder interests and demonstrated skills in facilitation, problem solving, decision making, persuasion and team-orientation.
Must be able to work in a Labor/Management Partnership environment.
Additional Preferred Qualifications:
Hospice care management experience and expertise.
TITLE: Regional Continuum Administrator, Hospice Care
LOCATION: Oakland, California
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.