Upvote
Downvote
Director, Senior Continuum Services
Share Job
- Suggest Revision
Full-time
- The Senior Director of Continuum Services, is responsible for the development, planning, management, and integration and delivery of Kaiser Foundation Health Plan Continuum of Care operational system processes and standards of practice, in alignment with the organizations mission, strategic business plan, and related performance improvement expectations.
- In collaboration with Regional Continuum of Care Administration, achieves/exceeds performance expectations for all areas of continuing care operations, including, but not limited to all outside medical services; hospital, Home Health, Hospice, SNF, DME, Ambulance, Claims and Referrals, Palliative Care, ESRD, Inpatient and Outpatient Psychiatry, Case Management, Continuing Care Utilization Management, Health Plan Benefit Application, Contracting, Emergency Care Management.
- Establishes policies, procedures and protocols for the reimbursement of claims submitted by KP members for outside services to maximize reimbursement revenue from other insurers (e.g., Medicare or Medicaid) with consistent appropriate interpretation and application of the health plan benefit.
- Contribute to the development of strategic plans to facilitate the Mid-Atlantic region reaching and exceeding its goals for effective management of patient day rate (PDR) and outside medical costs.
- Host regular Joint Operations Committee meetings with key vendor partners, including the areas of transportation, DME, as well as participate in UM JOCs with core hospitals, national buy to pay, SNF, HH, HO, Dialysis, and other strategic partners.
Active Job
Updated YesterdaySimilar Job
Relevance
Active