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Director of Inpatient Clinical Programs in Orange at Prospect Medical Systems

Date Posted: 2/25/2019

Job Snapshot

Job Description



Director of Inpatient Clinical Programs

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

Under the direction of the SVP, National Clinical Operations/Development, the Director of Inpatient Clinical Programs may be required to participate in the implementation of new multi-state, regional, clinical program development and implementation.Case Management and Care Transitions Programs for:  Utilization Management and Discharge Planning for all inpatient treatment facilities in and out-of-network. Responsible for oversight and operations of the licensed and non-licensed inpatient management teams. Mentors direct reports with assigned areas to include a thorough knowledge of the organization’s policies, procedures, work flow monitoring and oversight tools, employee relations, company goals and vision. Strong leadership skills with the ability to influence, manage, and motivate personnel. The ability to prioritize competing demands and promote a team environment with strong problem-solving skills and attention to detail. Responsible for consistent operational compliance and reporting to satisfy and exceed state, federal and accrediting agency standards. Participation in weekly Leadership, operational, department and external meetings as needed. Assist Medical Directors with daily operations and oversight of programs and compliance.  Liaison and key contact for executive and operational team members and is responsible for communication, coordination and monitoring of organization-wide initiatives and operations related to inpatient clinical programs. Under the direction of the SVP, National Clinical Operations/Development assists in budget planning and adherence to the organization’s goals and objectives. Other projects and duties as assigned.



Job Responsibilities/Duties

  • Responsible for interviewing, hiring, and retaining capable staff to execute the organization’s strategic and organizational plans and is responsible for succession planning and the development of identified leaders for advancement within the organization.
  • Insures that department policies and procedures support staff in daily activities and meet regulatory, contractual and accreditation standards.
  • Assists the Medical Directors in the development and application of utilization criteria.
  • Ensures that staff has thorough knowledge of the contracted health plan’s lines of business.
  • Coordinates utilization activities with case and disease management to improve health outcomes and promote appropriate use of resources. 
  • Mentors and collaborates with direct reports to develop and meet department and company objectives and strategic goals.  Ensures compliance is maintained with all regulatory reporting assigned to each manager.  Monitors staff hiring and disciplinary actions with any assigned staff.
  • Participates in Hospital/SNF Joint Operation Committees and ensures action items are resolved in a timely manner.
  • Provides consistently positive, constructive interface with internal departments as needed.
  • Identifies and develops new policies and procedures, then reviews outcomes that result in process improvement.
  • Daily Management of Case Management and Care Transitions from all inpatient treatment facilities, in and out-of-network. 
  • Daily oversight of inpatient census, Admits, Bed-days, Level of Care, related to department goals including appropriate and effective inpatient  Case Management, Hospitalist care, and Discharge planning. 
  • Works collaboratively with Medical Director and Hospitalists to ensure coverage is maintained, identify specialist issues, review one day Admits, Re-admits and Avoidable Bed-days. 
  • Maintains daily rounds with Hospitalist’s and weekly rounds with SNF team.   
  • Coordinates provisions for inpatient care including care transitions (Disease Management, Social Services, Behavioral Health, Palliative/ Hospice, Health Education, Community Resources, etc.)
  • Compiles and measures performance indicators, trends and staff activity reports relevant to UM/CM. Ensures compliance is maintained with all health plan, state, federal and accrediting agency standards e.g. NCQA/CMS regulations regarding health plan delegation.
  • Participates in the development and roll-out of new out-of-state regions/ACOs/New products, to ensure uniformity across all departments involved with Inpatient Clinical Programs.
  • Monitors compliance with achieving set goals and attending scheduled meetings.
  • Ensures annual fax blast notification of post-stabilization request to all California hospitals and manages coordination team who faxes real-time post-stabilization notification in the event Prospect does not receive a phone call.  
  • Developing and maintaining effective and efficient concurrent review and discharge planning processes with oversight and performance management of these functional areas: Inpatient/Skilled Nursing Facility Case Management:  Concurrent Review/ UM; Discharge Planning from Hospital; Discharge Planning from Skilled Nursing Facility (SNF); Care Transition planning, documentation and reporting.
  • Tracks, analyzes, and develops strategies to address outlier performance of utilization goal metrics such as: Admission, readmission and inpatient days/K and average length of stay; Trends by facility and practitioner, type of service and diagnosis; Emergency room visits/K; Hires, trains, and coaches supervisory staff.
  • Collaborates with interdisciplinary staff on special projects as required with duties including, but not limited to: Provides provider trainings as needed in conjunction with Provider Services; Assists in Quality Improvement activities; Participates in preparation of health plan audit and investigation activities; Participates in annual budgetary process; Develops departmental policies and procedures related to inpatient utilization processes.



Qualifications

Minimum Education: Bachleor's degree. 

Minimum Experience: Minimum of five (5) years of high level management (Manager or Director) experience in Medical Group, Health Plan and IPA arenas to include Utilization management, Quality Improvement, Inpatient Case Management Programs, Health Plan Incentive programs to include P4P/HCC.  Experience managing large staff.

Req. Certification/Licensure: Active, unrestricted, licensed RN or LVN. 



Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance


How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm



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