Washington, D.C.
San Antonio, Texas
San Marcos, Texas
San Antonio, Texas
Posted: 28-Jul-24
Location: Whittier, California
Salary: Open
Categories:
Internal Number: 22877
The Chief Operating Officer for the Management Services Organization (MSO) and Care Management reports to the President of PHP/HMS, and for care management dually to the President of PHP/HMS and the Chief Medical Officer for PIH Health. The COO has the authority, responsibility and accountability for the overall administration, direction and strategy of the MSO and Care Management departments across the PIH Health system. This includes oversight of all direct reports who lead the day-to-day activities and staffing for utilization management and review, care management, social work, discharge planning and access/bed control functions at each hospital campus and PHP. In addition, the COO has leadership and oversight over quality management, compliance, and claims management at the MSO. Collaborates with other members of the executive management team and physicians to fulfill the institution’s mission through safe, high quality and cost-effective care. Participates in the strategic planning process and works closely with the President of the MSO in establishing and executing initiatives leading to growth, financial performance, and provider relations. Acts as the primary link between the clinical and financial components of the organization in support of the delivery of appropriate, timely and accurate care management, social work, and patient placement. Additionally, this position participates and lead the clinical development, implementation, and transformation of new patient care models across the care management division.
PIH Health is a nonprofit, regional healthcare network that serves approximately 3.7 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 35 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.
- Excellent analytical skills to integrate and interpret data from diverse sources to address complex issues are required
- Demonstrated leadership ability to communicate effectively, both verbally and in writing
- Excellent interpersonal skills with the ability to work effectively across organizational lines and with a diverse group of people
- Must be able to demonstrate ability and skill through prior experience and/or academic expertise in actively leading and managing large-scale change.
- Must have expertise in data management and analysis related to length of stay, case mix, resource utilization, etc. with the intent of identifying opportunities for improvement as well as validating current performance.
- Ability to develop strong relationships with suppliers and customers, inside and outside of the organization, and to effectively communicate with employees, the medical staff and healthcare management staff
- Highly motivated, self-starter, values-based, energetic, enthusiastic, honest, and professional with strong personal integrity who has a pragmatic and proactive approach to problem solving
- An excellent manager who values employees and can build relationships with employees at all levels of the organization based on trust
- Creative, flexible, positive, and responsive to physician needs with good physician relations skills and a strong sense of urgency
- A team player as well as a team builder who is able to delegate appropriately, make difficult decisions and lead by example
- Must possess excellent verbal and written communication skills and thorough knowledge of processes and details integral to case management, social work, utilization review, discharge planning, clinical documentation improvement and bed control functions.
- Must have experience in planning and effectively managing departmental budgets and other fiscal responsibilities.
- Must have current knowledge of federal and health plan audit programs such as CMS RAC and other related audit activities, value-based purchasing programs, readmission and other related oversight programs resulting in denied reimbursements.
- Must have the ability to perform cost-benefit and detailed strategic analysis on data and information sets.
- Strong working knowledge of current ambulatory healthcare industry, as well as managed care experience working with Department of Managed Care.
Required:
· California Registered Nursing license, which is current, active and unrestricted
- Bachelor of Science Degree in Nursing
· Master of Science in Nursing, Public Health or Business Administration required
· Minimum of eight (8) years’ experience in case management, social work, utilization review, and discharge planning in an acute care hospital, IPA, or MSO including five (5) years of progressively responsible supervisory and administrative experience.
- Thorough working knowledge and understanding of Case Management and Quality Management procedures in a managed care setting including, but not limited to, HMO guidelines, criteria and division of financial responsibility; CMS guidelines; MCG guidelines, and Federal and State regulations. Facilitates conformance to DHCS, CMS, DMHC, NCQA and other regulatory requirements.
Preferred:
· Case Manager Certification (CCM) or Accredited Case Manager (ACM)