Purpose of Role

Under the general direction of the Sr. Director of Clinical Operations, the Director of Transitional Care Programs plans, organizes, and manages  all aspects of the Canopy Health Transitions program. The Director of Transitional Care Programs contributes to the design, development, effectiveness, and implementation of systems to actively monitor the safety and efficiency of care transitions and the continuum of inpatient and outpatient management of the Canopy Health patient population.Director of Transitional Care Programs also aligns work with Canopy health strategy and objectives; partners with leadership on development of standardized care transitions; works with various hospital partners in identifying opportunities for improvement of care and processes; collaborates with our medical group and hospital partners to ensure Canopy Health members receive personalized quality of care in the right settings.

Principal Accountabilities

1. Collaborates with physicians and other health care providers in establishing, implementing, and maintaining care transitions quality service standards to meet members and internal client’s expectations.

2.  Acts as patient advocate resolving patient care issues related to care transitions and other case management needs.

3.  Designs and evaluates processes to improve systems and patient care across the continuum of care.

4.  Assures systems are implemented to achieve targeted outcomes for care transitions but may also include length of stay and readmissions.

5.  Responsible for the development of systems and operations for care transitions and outcomes that may include social services, disease and population management.

6.  Responsible for coordination of a comprehensive care transitions program.

7.  Provides support for system-wide initiatives for providing the right care at the right time in the right place.

8.  Under the direction of the Senior Director of Clinical Operations, the director will also consider new aspects of care transitions programming as needed and will be responsible for independent bodies of work including: developing, deploying, and managing programs to support clinical integration and system improvement.

9.   Provide clinical and operational support to UM and CM departments to decrease overutilization, provide member-centric care, increase member engagement and ensure effective transitions of care.

10. The Director is responsible for mentoring and training staff and provides leadership in programs, operations, projects, policies and procedures to ensure high quality and efficient results.

11. Monitors financial performance and identifies and implements strategies to reduce costs and improve quality of care/service

12. Oversight of medically and psychosocially complex care transitions and repatriation as needed

13. Provides case management insight to the development and implementation of the Canopy Health transitions of Care Project and the Canopy Health Virtual Care Network Program

14. Works with the appropriate Clinical Departments, IT leadership, key hospital and outpatient operational areas, network partner institutions and administrative leadership to deploy meaningful analytics and metrics for care transitions

15. Responsible for managing quality and performance criteria, policies and procedures, and service standards for the care transitions program

16. With the Sr. Director of Clinical Operations and other Canopy Health Leadership analyze, interpret, and develop actions plans to meet company goals and priorities. Ensure plans integrate well across other departments in the continuum of care

17. Develops, implements, and monitors departmental policies and procedures which support the organizations goals and business objectives and ensures they are met

Minimum Requirements (Education/Experience/Skills/Certifications)

Education/License: Bachelor’s Degree in Nursing. Master’s degree in Case Management preferred

Active California Registered Nurse license

Current driver’s license

Experience:  5-10 years of nursing experience with a managed care organization in one of the following: medical group/IPA, health plan, hospital, or other health care focused (e.g. vendor) organization  

Knowledge/Skills Required: 

1. Passion about improving health care for members throughout the San Francisco Bay Area

2. Desire to make a positive impact for all members through innovations in clinical quality

3. In depth understanding of the principles and techniques of transitions of care and risk assessments tools

4. Case Management experience working with diverse populations

5. Thorough understanding of multiple healthcare reimbursement structures

6. Comfortable working with nurses, case managers, discharge planners, pharmacists, physicians, and others in an array of clinical care settings

7. Flexibility in handling multiple priorities across a federated model of care

8. Excellent relationship-building skills, across multiple organizations and cultures of care

9. Clinical acumen, critical thinking and enthusiasm for interpreting utilization and quality data

Benefits (What we offer)

·         Solution-oriented culture made up of innovators and change agents

·         Friendly, open, collaborative and flexible work environment

·         Competitive compensation and benefits package, including 401k match

·         Great central location, walking distance to a variety of restaurants/shops

·         Free parking and free shuttle bus to/from MacArthur BART