To plan, monitor, and evaluate the delivery of designated Health Services programs and functions for Partnership HealthPlan of California. Collaborates with Supervisor(s) to oversee the day-today department activities and provides guidance to manage these functions to enhance cost effectiveness, ensure compliance with applicable state and federal regulations, and to fulfill all contractual requirements.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Tracks, monitors, manages and distributes work and assignments to appropriate Health Services staff in accordance with job descriptions, practice level, and business needs.
- Works closely with Health Services leadership to develop meaningful performance measures to determine the quality, effectiveness, and efficiency of department operations in achieving desired outcomes.
- Provides administrative, technical, and clinical management of assigned staff in accordance with industry best practices which includes training oversight, the responsibility for hiring, performance evaluation, performance improvement, education, staff development, work allocation and problem resolution.
- Performs auditing and review for Health Services leadership including concurrent review, retrospective review, and individual case audits. Provides summary of findings to Health Services leadership as requested.
- Develops structures, relationships, and processes to promote active partnerships with providers, community stakeholders, and/or other healthcare professionals to meet organization's goal and mission.
- Ensures compliance with all departmental and organizational policy and procedures; develops and works with leadership to implement standardize processes to achieve efficient operations for the provision of optimal patient care.
- Reviews appropriate scope of practice by staff. Ensures that all team members are familiar with prominent professional standards especially related to issues such as confidentiality, informed consent, conflicts of interest, dual relationships, boundary issues, documentation, consultation, etc.
- Participates in all audits or surveys as requested by preparing documentation or reports as needed.
- Communicates activities and promotes continuous process improvement to ensure activities are appropriately managed with other departments and providers both within and outside the organization.
- Participates in identifying and developing departmental goals to further organizational goals and mission.
- Other duties as assigned.
MINIMUM HIRING CRITERIA
Education and Experience
Bachelors of Science in Nursing preferred; minimum five (5) years acute care experience, two (2) years managed care experience; or equivalent combination of education and experience. Minimum one (1) year prior experience in a leadership or management role.
Special Skills, Licenses and Certifications
Working knowledge of ICD-9-CM / ICD-10-CM, CPT coding schemes, length of stay guidelines, and clinical indications for inpatient stays. Current California Registered Nurse License. Certifications in chosen field such as advance practice nursing or case management. Strong knowledge of nursing standards in both inpatient and outpatient settings. Strongly leadership, program evaluation and management skills. Thorough knowledge of Care Coordination, Discharge Planning, Case Management and Utilization Review within a managed care environment. Familiarity of business practices and protocols accessing data sets and information using automated systems. Ability to work within an interdisciplinary structure and function independently in a fast-paced environment while managing multiple priorities and deadlines. Strong organizational skills required. Computer literacy and proficiency. Valid California Driver's License and proof of current automobile insurance compliant with PHC's policies are required to operate a vehicle and travel for company business.
Performance Based Competencies
Excellent written and verbal communication skills in English. Demonstrated experience and ability to build effective working relationships and to represent the department effectively in order to accomplish goals. Ability to manage multiple concurrent projects and maintain a work pace appropriate to the workload. Ability to assist individuals in recognizing and solving problems. Ability to supervise, train, motivate, provide guidance to staff.
Work Environment And Physical Demands
Daily use of multi-line telephone and computer for most of the day. Cubicle work station. Ability to use a computer keyboard. Must be able to lift, move, or carry objects of varying size, weighing up to 10lbs.
All HealthPlan employees are expected to: - Provide the highest possible level of service to clients; - Promote teamwork and cooperative effort among employees; - Maintain safe practices; and - Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.
Additional Salary Information: Please call 530-999-6875 to further discuss the position and salary information.
Partnership HealthPlan of California (PHC) is a non-profit community based health care organization that contracts with the State to administer Medi-Cal benefits through local care providers to ensure Medi-Cal recipients have access to high-quality comprehensive cost-effective health care. Our mission is simply this: “To help our members, and the communities we serve, be healthy.” We proudly stand... by this statement in everything we do.PHC provides quality health care to over 560,000 lives. Beginning in Solano County in 1994, PHC now provides services to 14 Northern California counties – Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Modoc, Napa, Shasta, Siskiyou, Solano, Sonoma, Trinity and Yolo.