Description

Job Summary:

To assist Kaiser Permanente in meeting contractual requirements, as specified by the Oregon Health Plan and Washington Basic Health Plus plan. To provide leadership, supervision, and management of multidisciplinary clinical and support staff (licensed and non-licensed in partnership with the Senior Manager, by providing Medicaid care coordination (MCC) for Medicaid members who are aged, blind, disabled, or who have needs above and beyond typical individuals of the same age. This position functions as a member of the Medicaid and Charitable Care leadership team, participating in strategic planning and design of clinical operations, managing the work of the MCC, and evaluating outcomes to ensure high quality member centered support and continuous process improvement. This position works closely with other managers across the organization and with external partners to ensure integration, collaboration, and support of organizational activities and goals.

Essential Responsibilities:

• Provide clinical and operational day to day leadership for staff providing care management services and other clinical operations and initiatives through MCC but not limited to the following:
• Hires, orients, trains, develop and supervise qualified and competent Medicaid and Charitable Program Care Coordination Staff.
• Provides performance feedback for evaluations.
• Provides clinical leadership in the development and review of clinical protocols and processes that support member centered care plans, appropriate referral and consistent quality care for members.
• Partner with the PHP Management/Leadership Team to promote strong teamwork and collaborative leadership.
• Responsible for the planning, coordination, and delivery of clinical services in compliance with all State and Federal regulations.
• Promote a high degree of intra-departmental collaboration and integration.
• Actively participate in annual program goal setting that aligns with organizational strategic goals.
• Develop and maintain strategic and operational partnerships with community-based social service organizations to assure we can leverage and improve access to upstream non-medical health-enhancing services for its members especially for those experiencing a transitions of care (TOC).
• Other Duties as assigned
• Provides training and development, performance coaching, on-time yearly performance review, and corrective action to assure effective delivery of quality clinical services.
• Serves as the primary preceptor for new employee orientation and training for the implementation of new processes.
• Support collaborative relationships with providers that promote and achieve goals.
• Provide staff with the training, mentoring and resources necessary to carry out their work and promote personal and professional development.
• Ensure adherence to department and organizational standards, policies, and procedures.
• Utilize process improvement methods to continuously evolve program processes toward greater efficiency and effectiveness.
• Demonstrate leadership effectiveness, analytical capability, and ability to design and implement constructive change and clinical initiatives to improve program and member outcomes in a team-based environment.
• Work in Collaboration with Sponsors and labor in UBT process and goals.
• Independently and proactively completes audit preparation including chart reviews, and full assessments related to the anticipated level of care and document findings using approved documentation tools.
• Triage findings from member assessments, identifying needs and issues and plan appropriate interventions. Determine Level of Care.
• Communicate findings and actions to involved care providers through succinct summaries that include findings, actions, and further recommendations.
• Manage Transitions of Care and internal and external referral process
• With the member/family and appropriate KP staff and providers, develop care plans that addresses short term goals that are specific, attainable, and measurable.
• Provide care coordination and management services for members with identified needs within the scope of the MCC role by: Creatively using available and appropriate resources, including KP staff and providers, to support the unique needs of each member; Facilitating access to internal and external services; Monitoring the effectiveness of the interventions; and Reinforcing the treatment plan through medication compliance including support for Opiate Therapy Plan compliance; and advising and coaching patients and families; Succinctly document interventions in Health Connect as needed by other providers to ensure coordination of care and services.

Basic Qualifications:

Experience

• Minimum four (4) years of direct patient care as a registered nurse/licensed social worker.
• Minimum two (2) years of experience in a nursing or equivalent clinical leadership role; supervision, management, or teaching

Education

• Bachelors degree in nursing or health related field.

License, Certification, Registration

• This job requires credentials from multiple states. Credentials from the primary work state are required at hire. Additional Credentials from the secondary work state(s) are required post hire.
  

• Registered Nurse License (Oregon) within 3 months of hire OR Licensed Clinical Social Worker (Oregon) within 3 months of hire

• Licensed Independent Clinical Social Worker (Washington) within 3 months of hire OR Compact License: Registered Nurse within 3 months of hire OR Licensed Advanced Social Worker License (Washington) within 3 months of hire OR Registered Nurse License (Washington) within 3 months of hire

• Driver's License (Oregon) within 1 months of hire OR Driver's License (Washington) within 1 months of hire

• Driver's License (from any state) required at hire
  

Additional Requirements:

• Experience in a nursing leadership role; supervision, management or teaching.
• Demonstrated ability to precept and mentor new staff; teaching and training to work unit processes.
• Demonstrated ability to support current staff with skill-building.
• Knowledge of case management principles.
• Knowledge of Oregon Health Plan, including ORS requirements, pharmacy rules and regulations and OHP list of treatable diseases.
• Knowledge of community resources for the care of the elderly and disabled.
• Demonstrates customer-focused service skills.
• Demonstrated ability to organize, coordinate, and manage care plans. Thorough knowledge of levels of care within outpatient, acute care, and extended care settings. Communicates this knowledge to other staff.
• Demonstrated ability to work as part of a multidisciplinary team.
• Excellent written and verbal communication skills.
• Ability to present reports verbally in a public setting (public speaking).
• Demonstrated data entry skills and ability to use Microsoft Word software.

Preferred Qualifications:

• Minimum four (4) years of experience in case management, care coordination, or population care preferred.
• Prior experience serving the mentally ill and or individuals with substance abuse issues.
• Prior experience as a care coordinator or discharge planner.
• Professional certification as a case manager.
• Knowledge of the Kaiser Permanente system, including HealthConnect.
• Knowledge of Medicaid/Medicare programs and regulations.
• Knowledge of quality management and utilization management principles.
• Masters degree in health care administration, business, nursing or related field.

Primary Location: Oregon,Portland,Kaiser Permanente Building
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 08:00 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard Worker Location: Flexible
Employee Status: Regular
Employee Group/Union Affiliation: NUE-NW-01|NUE|Non Union Employee
Job Level: Manager with Direct Reports
Department: Kaiser Permanente Building - Care & Coverage CB Operations - 1008
Pay Range: $125300 - $162140 / year Kaiser Permanente is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills and geographic location along with a review of current employees in similar roles to ensure that pay equity is achieved and maintained across Kaiser Permanente. Travel: Yes, 25 % of the Time Flexible: Work location is on-site at a KP location, with the flexibility to work from home. Worker location must align with Kaiser Permanente's Authorized States policy. Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.
Requisition #: 1394831

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