Manager, Medicaid & Charitable Care Coordinator at National Association of Latino Healthcare Executives

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.