Manager, Long Term Care / Job Req 671415433

PRINCIPAL RESPONSIBILITIES:

Under general direction of the Director of Clinical Initiatives and Leadership Development and working in cooperation with other departments, such as Utilization Management, is responsible for the oversight and operations of the Long-Term Care Department.  The Manager is knowledgeable of and responsible for compliance with regulatory requirements of Nursing Facility (NF-B)/Sub-Acute Facility (NF-A)/Distinct Part of Hospital (DP-H) long term care admissions, ICF and ICF/DD admissions, continued stay requirements as well as transitions of care to community settings and case management activities for long term care. The Manager provides leadership and executes decision-making based on subject matter expertise and judgment. This position is responsible for solving problems and for maintaining strong internal and external working relationships.

Principal responsibilities include:

General Management:

• Monitor program performance to maintain compliance with federal and state regulatory agencies.
• Ensure timely communication with the Director on all/any issues having potential risk and or impact on operations.
• Identify areas of concern and assist in providing feedback to staff and to other departments.
• Make decisions within department guidelines and policies, conduct staff training, and facilitate learning opportunities.
• Assist Director in preparation of department budget and performance review.
• Maintain quality management documents, case files, and correspondence in an organized, confidential, and secure manner.
• Participate in creating/revising policies and procedures, development of Quality Management (QM) reports.
• Maintain UM information system for tracking and reporting purposes.
• Prepare complete and accurate reports and presentations on long term care services.
• Identify trends, patterns, and opportunities for improvement in NF A&B/DP-H and communicate findings to appropriate Alliance committees; and
• Provide daily oversight of operations and staff.

• Establish workflows and member/facility communications templates in alignment with regulatory and contractual requirements.
• Oversee production of LTC documentation to ensure successful state/federal audit participation.
• Develops and implements departmental policies and procedures.
• Develops, implements, and monitors performance standards.
• Assures department meets all regulatory time frames.
• Facilitates inter-disciplinary meetings for LTC admissions. 
• Maintain an accurate and complete authorization records in the UM information system.
• Identify any program changes and updates requiring system changed; collaborate with the IT Dept. to ensure the regulatory requirements are in place for reporting accuracy.
• Support and coordinate the day-to-day department activities by coaching and assisting the clinical and non-clinical staff.
• Lead any technological implementations for the unit.
• Provide training, development, and continuing education to staff.
• Maintain professional and technical knowledge.
• Perform other duties and special projects as assigned.

• Conduct regular staff meetings to address common issues and identify opportunities for process improvement.
• Evaluate staff and develop corrective action and progressive disciplinary measures, as indicated.
• Provide subject matter expertise to Compliance, Customer Services, Health Care Services, Provider Relations and Claims management staff to ensure compliance with all regulatory, contractual and accreditation requirements.
• Develop evidence and documents for external audit, to include DMHC/DHCS audits, submission to include updated P&Ps, workflows, file universes and source documents.
• Conduct internal audits which include regular case audits, analyze results, and execute corrective action plans (CAP) to address any identified issues.
• Develop detailed corrective action plans that clearly identify the corrective actions steps required, timeframes, and individuals responsible for corrective action.

• Monitor the Daily Aging Report to track turnaround time for decision-making and ensure cases are entered into the information system and updated timely.

• Design and produce timely LTC reports in compliance with state and federal technical specifications.
• Communicate and collaborate with other departments to establish workflow processes.
• Serve as the primary liaison to resolve complex issues across departments.
• Coordinate across the organization to revise operational and reporting processes, as needed.

ESSENTIAL FUNCTIONS OF THE JOB

• Ensure the LTC Department operations comply with regulatory and contractual standards.
• Provides leadership and executes decision-making based subject matter expertise and judgment.
• Develop and maintain P&Ps and workflows in alignment with regulatory and contractual standards.
• Hire supervise and train staff.
• Prepare and deliver performance reviews.
• Ensure timely communication with Director on all/any issues having potential risk and or impact on operations.
• Maintain documents, case files, and databases in an organized, confidential, and secure manner.
• Oversee preparation of complete and accurate reports and presentations on long term care.
• Identify trends, patterns, and opportunities for improvement.
• Perform writing, analysis, and report preparation and
• Comply with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.

PHYSICAL REQUIREMENTS

• Constant and close visual work at desk or computer.
• Constant sitting and working at desk.
• Extensive data entry using keyboard and/or mouse.
• Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Occasional travel to hospitals and other facilities.
• Frequent lifting of folders and other objects weighing between 0 and 30 lbs.
• Frequent walking and standing.
• Occasional driving of automobiles.
• Occasional travel between offices for meetings

Number of Employees Supervised:  2-5

MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT TO:

• Bachelor of Science in Nursing or related field or equivalent experience preferred.
• Master of Science in Nursing or Health Administration or related field preferred.
• Registered Nurse (RN) - Active, current, and unrestricted California License, required
• Active & Current Driver's License, with a clean record and Auto Insurance, required
• Have a cleared TB test prior to or within seven days of hire.
• Current CPR and first aid card prior to or within six months of hire is preferred.
• Certified Professional Utilization Review/Utilization Management preferred.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

• Minimum five years of experience in managed care health plan, hospital, or similar setting, required.
• At least three years of management/supervisory experience and relevant health plan experience, required.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

• Experience with Medi-Cal and Medicare populations and regulatory requirements.
• Knowledge of DMHC regulations and DHCS contractual requirements.
• Experience in utilization review, skilled nursing services, home health, discharge planning, behavioral health, community resources, and/or other home and community-based agencies
• Knowledge of case/care management principles.
• Knowledge of principles of utilization management.
• Knowledge of health care contracts and benefit eligibility requirements.
• Knowledge of hospital structures and payment systems
• Proficient in use of computer and supporting software in a Windows-based environment including with Microsoft Office applications and use of the internet/internet applications.
• Excellent verbal and written communication skills.
• Experience in skilled or long-term care facility settings.
• Clinical experience working with individuals with chronic illnesses, comorbidities, and/or disabilities in a case/care management environment. 

SALARY RANGE $136,119.77-$204,179.66 ANNUALLY

The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.