Supervisor,Care Management,Transplant

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Responsible for performing administrative functions and providing direction for the Centralized Transplant Program, including program design and development, education and orientation of HealthCare Partners and IPA staff and medical providers and Transplant Centers; development and reporting of statistical and quality issues and reports, budget; staff supervision; preparation and conduct of transplant related meetings as well as provides complex and comprehensive medical case management service for the most catastrophically ill or complex transplant patients, using advanced nursing knowledge, experience, medical case management service for the most catastrophically ill or complex transplant patients, using advanced nursing knowledge, experience, medical case management, communication, negotiation, analytical and problem-solving skills in managing contracts, benefits, quality, risk management, resources, outcomes and cost issues, and the medical components of the transplant patients form all regions and IPAs.

Performs all administrative functions and direction for the HCP centralized transplant program.
Prepares, facilitates HCP administrative approval, and implements the department budget.
Determines hiring, staff recommendations and presents these to the HCP administration.
Educates/orients the Centralized Transplant Program Staff and HCP medical providers regarding transplant issues and transplant medical case management.
Designs, develops, and implements processes for the centralized transplant program, including computerization, patient education and outcome studies.
Assures patient eligibility, financial contact accountability, and health plan benefit determination for each patient referral; facilitates resolution on areas of conflict.
Provides specific clinical and plan of care information to contracting.
Prepares the department for nation al accreditation surveys using the appropriate standards of performance.
Obtains and analyses nationally developed qualitative and quantitative data to determine transplant center quality issues.
Negotiates designation of transplant center for patients with specific needs using medical documentation and UNOS data to support the HCP recommendation.
Obtains/implements transplant center protocols for pre/post procedure patient care.
Supervises clerical and professional staff, including determination of patient assignments.
Designs, implements, and facilitates data and statistical collection including outcome and quality of care information.
Prepares and conduct the centralized transplant committee meeting.
Consults with the appropriate centralized transplant program physicians regarding program and patient issues.
Facilitates team process problem resolution process using HCP administration, Medical Directors, Contracting, Risk Management, Behavioral health, Centralized Regional IPA administrative staff, Health Plans and Transplant Centers regarding complex patient issues. Analyzes and implements the results of the collaboration process.
Develops/ implements departmental policies and procedures.
Provides direct advances medical case management of problematic transplant patients, or complex transplant medical issues, including development of community and HCP resources for transplant patient care.
Uses advanced nursing knowledge, experience and skills in medical case management to transition the patient through the transplant process to medically acceptable lower levels or care; uses HCP resources in patient car as medically appropriate.
Analyzes and performs complex problem solving involving contracts, benefits, approval for medical appropriateness for transplant evaluations and procedures, designation of transplant center and implements the resolution.
Determines the clinical outcomes, patient satisfaction and cost-effective transplant patient plan of care, and obtains medical documentation to support medical case management decisions, and determines the financial implications of transplant patient care.
Negotiates plans of care with providers, including transplant centers.
Develops referral and authorizations for all patient care for the transplant patient, and assures contract and benefit compliance.
Develops and updates the transplant patient report and presents this report to the transplant committee.
Facilitates emergency procedures for Category I transplant patients, including the HCP and Health Plan approval process, the transfer to the transplant center and authorization of care.
Other duties as assigned.

Current RN license in California
Possesses or is qualified for the Certified case Management National Certification in Medical Case Management
Over 3 years and up to and including 5 years of experience
A bachelors degree from a four-year college and/or a professional certification requiring formal education beyond a two year college.
Clinical nursing experience in critical care or transplant patient care
Prior supervisory experience
Proficient computer skills
Excellent oral and written communication skills
Extensive skills in develop of team process, collaboration, negotiation, analyzing problematic and medical issues and implementing plan of action.
California Drivers license.