Manager of Clinical - Quality in Smithfield, RI

$80K - $100K(Ladders Estimates)

Neighborhood Health Plan of Rhode Island   •  

Smithfield, RI 02917

Industry: Education, Government & Non-Profit

  •  

Less than 5 years

Posted 52 days ago

Overview

The Manager of Clinical-Quality will report to the Director of Operations and Strategy – Primary Care, and work collaboratively with the Manager of Operations and the Supervisor of Operations to lead and oversee all aspects of clinical operations to support the Health@Home program clinical model of care and other programs for high-risk members. He/she will be responsible for developing and operationalizing new clinical initiatives for targeted populations, insuring that all relevant regulatory andcontractual requirements are met. This position will be responsible to identify, implement and manage clinical initiatives and pilots or the practice, engaging other internal and external partners as appropriate. He/she will have responsibility to establish relationships with primary care providers and facilitate opportunities for integration and collaboration. This position will serve as internal clinical consultant and subject matter expert with various departments such as Utilization Management, Case Management, Provider Network Management and Evaluation and Improvement to facilitate collaboration and process improvement opportunities that support effective clinical, quality and financial goals. He / she assumes accountability for timely and accurate identification, resolution and communication of issues related to clinical operations.

Responsibilities

  • Effective and ongoing collaboration with the Manager of Operations.
  • Contributes to the development of the organizations vision and strategy for assigned functions and responsibilities along with setting performance standards and productivity measures, and succession planning with department leadership
  • Develops , executes and evaluates work plans for area of responsibility
  • Oversees departmental talent, including hiring, training, and ongoing performance management and termination decisions for assigned staff
  • Creates and maintains all clinical policies and procedures, processes, workflows and communication strategy
  • Analysis of routine and ad hoc reports of program metrics, including but not limited to statereporting and quality measures to monitor performance and identify areas of opportunity. Responsible to present information to internal and external audiences as needed
  • Establishes and maintains relationships with various departments such as Provider Network Management, Utilization Management, Case Management , Pharmacy, and Behavioral Health, to identify areas of opportunity for collaboration and meet organizational business needs
  • Establishes and maintains relationships with external clinical partners (Universities, Department of Health Community Health Centers) to establish and provide clinical rotations, and identify and pilot clinical process improvement ideas
  • Monitors and manages (and make recommendations for) areas of responsibility related toprogram operations to ensure achievement of program goals, including but not limited to equipment, clinical services, rounds, case conferences, processes for member identification, outreach and engagement, documentation in the EMR, care plan development and ongoing patient visits
  • Identifies, explores, develops and implements continuous quality improvement activities for area of responsibility related to program clinical operations, new program development or new clinical initiatives.
  • Other duties as assigned
  • Participates in company committees as appropriate and needed
  • Participates in outreach/marketing activities as needed and as appropriate
  • Takes responsibility for professional development, supports learning environment and meets professional competency requirements
  • Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood's Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents

Qualifications

Required:

  • Registered Nurse with current and active license in the state of Rhode Island
  • Bachelor's degree in nursing or other health related field
  • Three (3 ) to five (5 ) years of experience in a clinical setting, managed care organization, or both
  • Two ( 2 ) or more years supervisory experience overseeing professional staff
  • Strong Electronic Medical Records ( EMR ) experience
  • Intermediate Microsoft Office (Project, Word, Excel, PowerPoint, Outlook)
  • Strong Organizational and documentation skills
  • Ability to manage multiple large projects simultaneously
  • Analytical skills with ability to critically evaluate situations and make recommendations
  • Demonstrated experience working with and managing relationships with relevant business partners
  • Strong working knowledge of HIPAA regulations
  • Excellent customer service orientation and interpersonal skills

Preferred:

  • Masters Degree – Business or Health Care related field
  • Advanced Microsoft Office (Project, Word, Excel, PowerPoint, Outlook)
  • Bilingual
  • Managed care and / or medical office experience

Organizational Competencies:

  • Judgment and Decision Making
  • Gets Results
  • Collaboration and Teamwork
  • Business Awareness
  • Customer Focus

Job Specific Competencies:

  • Creativity & Innovation
  • Flexibility & Achieving Change
  • Continuous Quality Improvement
  • Planning & Organizing
  • Problem Solving & Analysis

FDR Oversight:

  • Business Lead Level:

In the role of business lead for assigned FDR; incumbent is responsible to complete comprehensive oversight and monitoring of their vendor that incorporates the following elements: efficient and effective operations; compliance with laws, regulations, policies, procedures; and other company performance issues designed to reduce risk and add value to the company

Travel Expectations:

  • 10%


2019-10523

Valid Through: 2019-10-18