Senior Director Clinical Services
SENIOR DIRECTOR OF CLINICAL SERVICES
The Center for Elders’ Independence is a PACE (Program of All-Inclusive Care for the Elderly) organization that uses an interdisciplinary team approach to care planning and care implementation for the purpose of providing high quality, affordable, integrated health care services to the elderly, including an Adult Day Health Center, and promoting autonomy, quality of life and the ability of individuals to live in their communities.
The Position: Responsible for management, quality, and utilization of clinical services across CEI programs at multiple sites and for oversight of home care and clinical home health services and centralized continuing care service hub including telephone advice and management of participants in various settings such as home, skilled nursing facilities, RCFE’s, and hospitals. Accountable for hiring, training, performance, and fiscal management of personnel. Responsible for the oversight of CEI’s Home and Community Based Medi-Cal Waiver program (HCBA). Ensures clinical practice is aligned to PACE, federal, state, and local regulations.
Duties and Responsibilities:
- In collaboration with operations leaders ensures acceptable standards of care, based on applicable regulatory standards, including but not limited to: California State Board of Nursing, CMS PACE, DHCS Medi-Cal, Commission on Dietetic Registration, Rehabilitation and Social Work Standards for practice, as well as CEI’s standards, policies and procedures.
- Ensures all clinical and nursing policy, safety, protocols, guidelines, and facility requirements are being met.
- In conjunction with peer senior leaders, leads clinical program team in audit activities, especially in preparation for regulatory audits. Ensures adherence to required monitoring and surveillance requirements for process and quality improvement initiatives.
- Evaluates and assigns performance improvement projects for functional managers in coordination with Quality Assurance and Administrative and Medical Leadership.
- Directs the monitoring of quality and compliance with all clinical standards (including, but not limited to, development of audits for EHR documentation and facility audits as it relates to disciplines, as well as clinical competency program).
- Oversees the Director of In Home Services to ensure home care and home health services align with IDT recommendation/care plan and efficiency of quality service delivery
- Oversees the Director of In Home Services and provides strategic direction for In-Home Services and the Continuing Care Service Center team.
- Provides direct supervision for the referral coordinator team to ensure adherence to established processes and engage in process improvement projects to increase efficiencies and best practices.
- Oversees the Director of In Home Services ongoing operations direction for centralized continuing care services for participants including, but not limited to a 24-hour high quality service center to provide timely telephone advice, skilled nursing placement and discharge, hospital care and discharge, and related services such as durable medical equipment
- Oversees the Manager of HCBA program. Responsible for identifying continued growth opportunities for the HCBA program while maintaining regulatory compliance and high client satisfaction
- Collaborates with CMO and Director of Quality and Process Improvement on quality and clinical process improvement projects
- Partners with health care providers outside the organization, in collaboration with CMO, to achieve optimal participant care and outcomes across the continuum. Develops and manages systems and relationships with outside vendors; contract and quality oversight with external vendors
- Develops, implements, and monitors departmental goals, policy along with procedures that support organizational objectives and ensures compliance
- Researches, identifies, and implements best practice models. Oversees and develops department standards of care and practice as well as quality improvement activities
- Determines appropriate staff mix for areas of responsibility, collaborates with department leaders to develop processes to screen, interview, hire, train, coach, and maintain the competency of staff
- Manages and resolves human resource, employee/department safety, and risk management issues in collaboration with direct reports and peer leaders
- Develops and monitors financial performance and use of appropriate resources. Identifies and implements strategies to improve quality, service, and efficiency while effectively managing costs.
- Directs investigation and satisfactory resolution to participant/family concerns regarding patient care
- Ensures budget adherence within areas of oversight responsibility
- Under the direction of the SVP, PACE Operations collaborates with other CEI leaders to drive consistency of operations and performance improvement. Partners with colleagues to identify and implement innovative models and best practices; and develop strategic plans that assure quality care and cost-effective services, aligned with federal, state, and local regulations.
- Ensures compliance with administrative, legal, and regulatory requirements of the Health Plan contract and governmental and accrediting agencies. Maintains a state of continuous regulatory readiness
• MSN or Master’s degree in health care related field or combination of Bachelor’s degree and 5-10 years’ experience in a senior leadership role required
• Graduate of an accredited school of nursing
• Current California RN license required
• CPR certificate required
• Substantial managed care and/or case management experience required (usually 6 years)
• Progressive management experience required (usually 5 years)
• Demonstrated knowledge of, Federal HMO Act, Nurse Practice Act, PACE, and all other local, state, and federal regulations
• Demonstrated strong interpersonal communication skills
• Demonstrated experience with the EMR (electronic medical record). Strong computer skills – word processing, spreadsheets and databases.
• Ability to perform duties in heavy workload environment
• Experience in medical office/ambulatory care and computerized staffing /scheduling preferred
The above job description is intended to communicate the general function of the mentioned position and by no means shall be considered an exhaustive or complete outline of the specific tasks and functions that will be required. CEI reserves the right to change job descriptions, site assignments, and or work hours as required by the needs of the program. All employees are expected to perform their duties within their ability as required by the job and/or as requested by management.
SUPERVISED BY: SVP PACE Operations
POSITION SUPERVISES EMPLOYEES: Yes
Center for Elders’ Independence is a PACE (Program of All- Inclusive Care for the Elderly) organization that uses an interdisciplinary team approach to care planning and care implementation for the purpose of providing high quality, affordable, integrated health care services to the elderly, including an Adult Day Health Center, and promoting autonomy, quality of life and the ability of individuals to live in their communities. Unlike other healthcare plans, CEI is not a "fee-for-service" plan. It is a “capitation” healthcare plan. CEI is paid a set amount for each person enrolled in our program, whether or not that individual seeks care. We are a growing company that offers stability and continues to thrive.