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THE ROLE
The Director of Care Management (CM) is responsible for strategic leadership and management of initiatives to improve population outcomes related to clinical quality and total cost of care for Providence Medical Group (PMG) clinics across the Oregon Region. This position develops, implements, and reports on PMG Care Management strategic initiatives in the Oregon Region and represents PMG CM on Providence St. Joseph Health System level work.
The Director is responsible for the success of the multi-disciplinary Care Management teams, align PMG CM practices across the Oregon Region, and ensure the delivery of excellent service, high quality care and financial performance. This position is responsible for developing data-driven strategic, operational and implementation plans – in collaboration with other PMG departments, clinics not in a direct line reporting relationship, and community partners – for multiple PMG initiatives to achieve population health objectives in service to our core organizational strategy of "Creating healthier communities, together." This position will have oversight and management accountability for care-coordination functions including embedded complex case management, centralized care-coordination support programs which serve the whole Region, and specific disease management activities. The Director works collaboratively with multidisciplinary teams across the Region's care continuum to assure coordination of care.
This position will contribute to education and leadership to enhance provider engagement and understanding of the total cost of care of their patient population. This position is part of the PMG Clinical Leadership Team and works closely with PMG clinical and operational leadership and the departments relating to informatics, finance, pharmacy, education, training and outcomes evaluation to achieve breakthrough population health performance. This position also works collaboratively with health plan leaders where PMG has risk-based contracts to ensure efficient use of resources and to deliver on defined cost of care goals. This position supports Patient Centered Primary Care Home (PCPCH) model development and ongoing evolution and implementation.
MAJOR CHALLENGES:
- Facilitating process design and quality improvement strategies in an environment of competing priorities for staff time and resources.
- Maintaining a progressive case and medical management strategy within the current healthcare environment given healthcare reimbursement constraints, complex systems, and general resistance to change.
- Balancing the needs across PMG and the needs of an integrated system.
- Ensuring focus on quality improvement and patient outcomes while recognizing individual autonomy and creativity.
- Measuring outcomes of PMG population health initiatives and total cost of care and communicating results to various stakeholders.
ESSENTIAL FUNCTIONS
- Collaborates on the development of utilization profiles by provider, clinic, area and region to analyze patterns and trends related to care coordination, transitions of care and medical management performance.
- Works closely with Regional Executive Director of Care Management and other partners on the Care Management Integration Council to improve communication and collaboration during transitions of care while identifying gaps in care and process improvement.
- Works closely with the PMG Directors on PCPCH, CPCI, CCO and ACO requirements and milestones identifying, stratifying, implementing and measuring value and success parameters.
- Provides leadership and strategic planning to operationalize Care management and care coordination services across the Oregon region for at-risk patients, establishing standard processes where appropriate.
- Directs the daily operations of the PMG Care Management Department.
- Facilitates collaboration among Oregon Region entities, including Providence Health Plan, to develop and facilitate best practices in CM and care coordination. Leads, charters and/or participates in region-wide CM teams including the CM Integration Council.
- Develops and has responsibility over PMG CM region wide strategic plan activities.
- Oversight of hiring, orientation, development and appraisal of staff, to motivate and retain competent personnel. Monitors turnover.
- Develops, delegates and communicates accountabilities and priorities for staff.
- Prepares, presents and controls the annual operational budget of the department. Evaluates actual vs. budgeted expenses. Identifies, explains and reports variances.
- Prepares regular reports of departmental activity.
- Establishes and meets department goals, objectives and action plans.
- Facilitates team development, function and problem solving.
- Researches and implements best practice models to support innovation and rapid organizational learning in partnership with clinical and operational leadership within PMG and across the care continuum.
QUALIFICATIONS
- Bachelor's Degree from an accredited school of Nursing
- Master's Degree in Nursing or related field, or Social Work from a Council of Social Work Education (CSWE) Accredited School of Social Work or from a school in candidacy status by CSWE; or equivalent educ/experience
- Upon hire: Oregon Registered Nurse License (Vendor Managed)
- Preferred upon hire: Current recognition by a national professional organization in utilization management, case management or quality improvement
- 10 or more years of demonstrated experience and success in implementing and managing organizational processes involving case and disease management, medical management, physician engagement and education, and financial review of total cost of care
- 7 years of progressive responsibility in leadership within a health care organization
- Experience in leveraging information technology for clinical and operational improvement
- Track record of embracing a leadership role that required making difficult decisions, communicating with large diverse audiences, and effectively influencing others without authority
- Demonstrated success in developing and implementing strategies to improve care coordination throughout the continuum of care
- Demonstrated success with organizational change management and streamlining process improvement
- Experience with physicians and demonstrated ability to work with medical leaders
- Knowledge of the healthcare industry with a focus on population health strategies and implementation of data-driven interventions
- Ability to address issues through innovative solutions. These innovations are intended to help improve the patient experience, affordability and quality
- Ability to lead transition processes within a complex, highly matrixed organization
- Ability to establish organizational structures and management systems to achieve administrative and clinical integration across the continuum of care
- Strong problem solving skills with the ability to comprehend complicated issues and formulate and implement creative strategies and service delivery solutions
- Demonstrated ability in leading cross-functional teams and maintaining positive professional relationships to meet organizational goals
- Ability to provide direction and leadership to guide and support physicians, managers and staff through organizational change
- Strong analytic skills
- Proven ability to prioritize and manage multiple projects, from conception and planning through implementation
- Ability to provide responsive leadership to delegate, coordinate and motivate individuals and teams and evaluate performance
- Strong working knowledge of clinic operations and physician group practices, financial management, cost analysis, information systems and insurance contracts
- Broad knowledge and understanding of the trends and changes taking place in health care and their implications
- Problem-solver who involves others in key decisions but assures timely decisions are made
- Ability to establish relationships with diverse groups
- Strong written and verbal communication skills, and good listening skills.
About Providence
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Check out our benefits page for more information about our Benefits and Rewards.
Requsition ID: 242287
Company: Providence Jobs
Job Category:Care Management
Job Function: Clinical Care
Job Schedule: Full time
Job Shift: Day
Career Track: Leadership
Department: 5011 PMG N CASE MGMT
Address: OR Portland 4400 NE Halsey St
Work Location: Providence Office Park Portland Bldg 1-Portland
Pay Range: $62.36 - $102.37
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Check out our benefits page for more information about our Benefits and Rewards.
Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
