VP Care Management

Company: Optum
Location: Tacoma
Posted on: October 15, 2020

Job Description:

VP Care Management OptumCare is a network of health care providers in local markets whose mission is to help providers deliver the most effective and compassionate care to each patient they serve. OptumCares primary focus is on doing the right things for patients, physicians, and the community. It uses an innovative service model focused on measuring what matters and increasing efficiency and performance while providing the highest level of customer service. This model allows OC to make a difference each day by delivering highly personal, customized care management to its patients.OptumCare is succeeding at helping people live healthier lives by taking a different approach to health care. OC uses a commonsense approach, focused on avoiding jargon, finding more efficient ways to operate, and providing great, in-the-moment service. We provide that service by making sure serving our patients and providers is always the first priority. Each department works from the same central idea: How does this affect the service we provide? Because of the extreme commitment to service, OC focuses on recruiting passionate employees who will take advantage of being empowered to provide the highest level of service at each and every step.The Vice President of Care Management is responsible for the oversight, management and optimization of all CQI, UM and Care Management activities as they relate to inpatient, social service, home health, DME and other healthcare delivery programs within the Washington Region. The VP partners with executive leaders to provide strategic direction and leadership in executing regional clinical operations. Works with other members of the clinical operations team to ensure the clinical, quality, financial and patient satisfaction outcomes are met throughout the Washington Region.Major ResponsibilitiesConsistently exhibits behavior and communication skills that demonstrate Optum Cares commitment to superior customer service, including quality, care and concern with each internal and external customer.Identifies need for and participates in the development and implementation of care management and utilization management policies and procedures and ensures compliance throughout the region and consistency throughout the network.Monitors closely and analyzes all inpatient and outpatient reports and identifies trends. Makes recommendations to the Regional Accountable Team (RAT) regarding interventions to improve all resource management.Develops and coordinates strategies for ensuring the delivery of care in the most appropriate setting.Provides oversight and ensures that contracted providers are used and collaborates with Contracting department to obtain new contracts with preferred providers based upon specific quality and utilization criteria.Provides oversight of all high-risk/high-cost patients in regard to care delivery, referrals, contracting, etc. Oversees cross regional high-cost areas of Care Management (i.e., transplant or high-volume complex lines of business such asIPA/group).Provides oversight of provider referral patterns for appropriate utilization of specialty and ancillary services.Initiates organizational and system changes to improve departmental staffing efficiency and effectiveness, and care management program outcomes within the region.Coordinates or performs projects/activities as delegated by organizational committees and Supervisor.Participates and supports organizational committees as appropriate including the Health Plan Joint Operating Committees per regulatory guidelines.Identifies, develops and oversees the educational needs of the Care Management providers and staff including the implementation of an extensive orientation program, cross-training and proactive approach to Care Management.Identifies opportunities for the development of new care management approaches and prepares proposals with cost analysis, IS requirements, educational needs and implementation plan to be presented to the centralized team for network-wide implementation.Oversees the regional business plans, budget and bed day plans with respect to Care Management.Motivates and leads the Care Management staff in setting and reaching goals for continuous improvement in quality, service and cost-effective care to all HCP customers. Leads cross-regional meetings for all of Care Management.Works with Managed Care Applications in the development of reports to meet health plan regulatory requirements and to provide tools for the Regional Accountable Teams (RATs) to assist in the management of bed days.Works with Quality Improvement and Risk Management to identify areas of potential risks to the organization and to develop actions to minimize the risks.Works with the Corporate Liaison of the Hospitalist Program to develop plans in the management of bed day utilization to ensure that members receive quality care at the appropriate level.Implements standardization of Care Management programs throughout all regions and ensures consistent decision making through the development and utilization of Inter-Rate Reliability tools.Assists with the monitoring and evaluation of the IMCS process as it relates to Care Management to ensure timely and accurate processing of referrals that come through the Care Management department.Uses, protects, and discloses HCP patients protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.QualificationsEducation: BSN, Masters preferredExperience: 7 years broad based clinical experience7 years management experience of professional and technical staff7 years nursing leadership experience in developing case management functionsCertification/License:Current unrestricted RN License in the State of WashingtonCurrent drivers licenseby Jobble

Keywords: Optum, Tacoma , VP Care Management, Executive , Tacoma, Washington