Manager, Health Resources - 26-40

We’re delighted you’re considering joining us!

At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

Join Our Team!

Hill Physicians has much to offer prospective employees. We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.

DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

Overall management for daily operations of Clinical Services functions in alignment with organizational strategic goals and objectives. The Manager is responsible for overseeing the efficient coordination and management of multiple departments within clinical services. Implement and manage programs that maximize care quality and continuity, improve the patient experience, and increase value through utilization of appropriate resources and coordination of care in the appropriate care setting.

Job Responsibilities:

• Supervise and coordinate centralized operations across inpatient case management, SNF review, ambulatory care management, prior authorization departments and other departments across clinical services.
• implement organization strategic plans, goals and objectives; routinely monitor progress and accomplishments; implement initiatives to improve resource utilization, efficiency and quality of service delivery and work flows.
• Develop and implement process improvements to enhance efficiency, quality, and patient outcomes.
• Monitor performance metrics and prepare reports for leadership, identifying opportunities for improvement.
• Monitor high-risk/high-cost/high-utilizing patients; assure appropriate care in appropriate setting and facilitate necessary referrals to supportive programs.
• Ensure compliance with regulatory and organizational standards in all operational processes.
• Participate in implementing initiatives and tactical plan tasks related to accountable care and strategic projects. Support change management efforts in integrating health care delivery systems, such as process redesign, work restructuring, technological innovations, and shifts in the focus of care.
• Develop and implement policies and operational procedures. Collaborate with other departments and regions to ensure consistency in application.
• Assure use of contracted network providers and collaborate with Regional Services and the Contracting and Network Development department to obtain new provider contracts based on MOU trends.
• Collaborate with clinical and non-clinical staff to support integrated care delivery and effective communication.
• Provide coaching, training, and support to department staff, fostering a positive and productive work environment.
• Create a work environment that fosters respect and positive morale. Guide supervisors in providing staff direction. Effectively allocate and evaluate department work; identify required staffing levels, and provide leadership and follow-through to ensure that department services are delivered in a timely, efficient manner.
• Promote professional development to maximize individual and department competency; serve as mentor promoting professionalism on a group or individual basis.
• Ensure adherence to Human Resources policies and guidelines. Define expectations for performance and hold subordinates accountable. Participate with human resources management including hiring, firing, training, annual performance evaluations, and positive discipline.
• Implement departmental policies and procedures that comply with all applicable laws, regulatory agency requirements, health plan delegation and accreditation standards, standards of practice, and organizational service, quality and safety standards.
• Participate in the departmental budget planning process; adhere to approved budget.
• Collaborate with PriMed departments, medical leadership and network providers, staff, and health plans to facilitate information-sharing, collaborative problem-solving and adequate provision of support services. Represent Clinical Services on inter-departmental committees as appropriate.
• Other duties as assigned.
  
  
  

Required Experience:

• LVN or non-licensed with minimum of five years healthcare experience
• Bachelor’s degree in healthcare administration or related field
• Minimum 3 years management experience in a managed care setting
• Demonstrated ability to effectively manage change and conflict
• Attentiveness to detail, exhibiting self-direction, high degree of independence, judgment and discretion, teaching ability, effective oral and written communication skills, demonstrate ability to work effectively with others as a team member
• Demonstrated ability to create high-performing teams
• Must demonstrate customer service skills appropriate to the job
• Ability to establish and maintain effective working relationships with internal and external stakeholders across the health care delivery system
• Excellent written and verbal communication skills in English; must demonstrate ability to effectively communicate with staff and management
• Demonstrated computer skills in MS Office programs including Word, Excel and Outlook
  
  
  

Preferred Education:

• Case management knowledge and experience in a healthcare e.g. inpatient and/or outpatient utilization management, discharge planning, complex case management Epic experience
• Case Management Certification
• Utilization Management Certification
  
  
  

Additional Information

Salary: $127,000 - $157,000 Annual

Hill Physicians is an Equal Opportunity Employer