Manager, Health Services - 25 - 192

Joining Our Team At Hill Physicians Medical Group

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.

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.

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 general management responsibilities for daily operations of Concurrent Review functions in alignment with organizational strategic goals and objectives. 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

Coordinate with Director to 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.

Collaborate with other PriMed staff in supporting the Hill Physicians Medical Management Program.

Monitor high-risk/high-cost/high-utilizing patients; assure appropriate care in appropriate setting and facilitate necessary referrals to supportive programs.

Ensure departmental and regulatory standards are met. Collaborate with medical staff for as required needed.

Participate in implementing initiatives and tactical plan tasks related to accountable care (ACO) 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.

Maximize patient satisfaction with Medical Management programs and serve as a role model for excellent service. Ensure all staff members are appropriately trained. Reinforce behaviors and standards among staff that lead to positive interactions with internal and external PriMed customers, including members, ACO partners, facilities, Health Plans and others.

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.

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.

Collaborate with Director, HRM management, and educational resources to develop mechanisms for 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 Concurrent Review on inter-departmental committees as appropriate.

Other duties as assigned.

Required Experience

Active unrestricted California RN license

Bachelor's degree in nursing or related field, or equivalent combination of experience and education

Minimum 5 years of clinical experience

Minimum 3 years management experience in a managed care setting

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

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

Master's degree in Nursing or related health field

Case Management Certification

Utilization Management Certification

Additional Information

Work Locations: Sacramento, San Ramon or Stockton – remote considered

Salary: $125,000 - $154,000 Annual

Hill Physicians is an Equal Opportunity Employer