Director, Clinical Excellence (Post Acute, VBC)

Who We Are

Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. We believe patients living with kidney disease deserve the best care. We are committed to improving patient outcomes and improving quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants.

We help nephrologists focus on the right patients at the right time across the full care spectrum. We do this by providing them with the best-in-class interdisciplinary clinical resources, analytical insight and tools, and services to patients. We listen to the needs of our patients, our employees, and our client partners, continually working to push beyond the status quo in which the care system manages patients today.

Who You Are

You are devoted, compassionate, and enjoy being on the front lines of healthcare, changing the lives of patients by supporting them and the team by focusing on customers. You’re excited about being part of a team that is building a healthcare delivery model that ensures the highest possible quality of life and best outcomes for those in our care. You believe people living with kidney disease deserve the best person-centered, holistic, comprehensive care and want to influence the healthcare system to drive towards that. You thrive in innovative and evolving environments with high rates of change.

Your Role

As a Director, Post-Acute Care and Kidney Care Excellence, you play a key leadership role in ensuring patients experience seamless, high-quality transitions across the post-acute care continuum, hospital to SNF to home. You will oversee the day-to-day operational delivery of Evergreen’s post-acute care program. In this position, you are responsible for working in a highly matrixed environment and partner closely with nephrologist medical directors, market leaders, practice partners, SNF leaders, and interdisciplinary care teams. In collaboration with senior leadership, you will lead the successful execution of the PAC workflows across Evergreen’s markets with clear role accountability. You will use data to drive decisions, identify trends and implement continuous improvements that advance Evergreen’s post-acute strategy and uphold our mission to transform kidney care. This role requires a strong clinical background, operational discipline and the ability to lead a high performing team.

Role Responsibilities

• Lead the operational delivery of the PAC program across assigned markets so that patients moving from hospital to SNF and from SNF to home receive coordinated care 
• Build and maintain strong SNF partnerships, standard clinical performance expectations, and clear escalation paths to resolve barriers to care. Understand and lead escalation pathways and communication with nephrologist and practices 
• Ensure consistent, reliable execution of PAC workflows including SNF engagement, identification in hospital, SNF admission review, care plan alignment with nephrologist, length-of-stay management, discharge readiness, patient benefit and coordination with CM teams such as EG Compassionate Care and CCPM programs 
• Lead, coach, and develop the PAC clinical team  
• Track and report KPIs and outcomes such as SNF length of stay, time to first post-discharge visit, readmissions, avoidable ED use, patient experience, and program reach 
• In collaboration with senior leadership, use data to identify trends and close gaps in quality of care and meet Evergreen’s KPIs and productivity measures for the PAC team 
• Partner across all departments to ensure smooth handoffs, integrated care.  
  Ensure compliance with CMS and payer requirements and support readiness for audits and accreditation activities 
• Contribute to Evergreen’s culture of learning, iteration, and rapid improvement 
• Other duties consistent with this role, as assigned

Required Qualifications

• Licensed RN, NP, or PA 
• Bachelor’s degree in Nursing or a related field; Master’s degree preferred  
• Minimum 3 years of clinical leadership in care management or post-acute settings with direct responsibility for SNF or PAC operations 
• Demonstrated experience in value-based care and using data to improve quality and reduce unnecessary utilization including performance dashboards, workflow tools and basic analytics 
• Proven ability to lead interdisciplinary teams and to work effectively in a highly matrixed, fast-moving organization 
• Excellent communication and relationship skills with a track record of building trust with clinicians, facility partners, and operational teams
• Skilled with MS Offic