This job is located in Milledgeville, GA.
JOB SUMMARY :
The Clinical Program Manager is responsible for supporting cost-effective, high-quality health care for patients enrolled in long-term care facilities within a designated region by managing the activities performed by a team of Providers and to support national clinical strategy and leadership. This position is responsible for conducting clinical audits of the providers to ensure excellent delivery of service and verifying that care is administered in accordance with all compliance programs, Medicare, Medicare Advantage, state laws and regulatory compliance, privacy and security.
ESSENTIAL JOB DUTIES :
To perform this job, an individual must perform each essential function satisfactorily, with or without a reasonable accommodation.
- Work closely with the leadership at the long-term care facilities in their region and company leadership to meet the key performance metrics for a market
- Directly manage a team of Providers and RN Case Managers who provide care within nursing facilities
- Ensure all patient services are delivered timely, effectively and within the scope of the plan
- Collaborate with colleagues to explore innovative delivery models or enhancements to current delivery models and care
practices
Identify opportunities for process improvements and staff education to produce optimal outcomesServe as a subject matter expert (SME) on the institutional special needs plans (I-SNP) and care modelCollaborate on the development of training materials to support clinical trainingParticipate in clinical training initiativesCollaborate with business leaders to implement new markets and programsReview daily, weekly and monthly management reports to monitor and manage care deliveryCollaborate with vendors and community organizations for improved service deliveryOversee the review and resolution of complaints and grievancesParticipate in company-wide initiatives to ensure consistency and high-quality in the clinical delivery of careParticipate in company-wide quality improvement initiatives across all aspects of the organizationEnsure care is provided in compliance with all state laws and regulationsDetect, prevent and correct fraud, waste and abuseOther duties as assignedJOB REQUIREMENTS :
Ability to work designated schedule, reliable attendanceSkilled business backgroundProficient leadership skillsKnowledge of HEDIS and STAR ratingsKnowledge of Medicare, Medicaid, I-SNP, Nursing Facility and Managed CareProficient knowledge of Microsoft Office applicationsREQUIRED QUALIFICATIONS :
Education :
Master's degree in nursingExperience :
3 to 5 years' experience in long-term care or with chronically ill patients3-5 years of practice experience1-3 years management experience in long-term care, home health or chronic condition management preferredVast experience in leadership and business preferredExtensive knowledge and experience with Medicare, Medicaid, I-SNP, Nursing Facility and Managed Carepreferred
HEDIS / STARs experience preferredLicense / Certification(s) :
APRN or PA license requiredSUPERVISORY RESPONSIBILITES :
First line supervision and delegation of duties to all Providers (NPs / PAs) and RN Case Managers in direct clinical careservices
Frontline oversight, planning, and delegation of onboarding activities of new employees within the designated regionResponsible for provider relations issues below regional or corporate levels that would affect P&PsSupervise support staff including scheduling and assigning work, reviewing performance, recommending salary increases,promotions or discharges
Occasionally needs manager's direction due to extraordinary circumstancesEQUAL OPPORTUNITY EMPLOYER
This Organization is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. This Organization will make reasonable accommodations for qualified individuals with disabilities should a request for an
accommodation be made. A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with the Organization including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment. Licenses & Certifications Required
Family Nurse PractitionerNurse PractitionerAPRN Advanced Practice RNPhysician AssistantEqual Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.