Description: Reports to the Dir, Specialty Care Operations and has direct accountability to enhance the overall performance of the clinical care provided within the assigned specialties within the region. Provides direct supervision and coaching for Health plan staff within specific teams or facilities, working with the Chiefs of Service and Dir, Specialty Care Operations, to create high performance teams providing integrated and coordinated care that delights our customers leading to loyalty and retention. Collaborates with the Chiefs of Service and Dir, Specialty Care Operations in managing the health care team(s) financial performance, staffing and resource allocation within defined parameters that enhances the overall performance of the team, facility, and organization. Ensures the delivery of high quality care and service that meets defined standards and consistent compliance with clinical guidelines and processes optimizing operational excellence.
- Assists in the facilitation and building of self-directed teams, by demonstrating effective team management skills (negotiation, conflict resolution, mentoring, coaching, giving and receiving feedback).
- Assists in the development and monitoring of team/facility budgets and financial performance using quantitative information to manage and make decisions that enhance the team's, facility and organizational performance.
- Supports and leads new initiatives, including but not limited to, POC, PCMH, and others.
- Leads change positively and effectively.
- Expresses self clearly and communicates timely and accurate information both in one to one interactions and groups, allowing for flow of information. Plans, coordinates, and facilitates facility and/or team meetings with the Chief of Service.
- Participates in the interviewing and selection of team members that meet the clinical and behavioral parameters of a high performance team. Coordinates selection process and orientation and training of new health care team members.
- Manages team conflict effectively, fostering collaboration and resolution.
- Makes timely, ethical, and firm business and clinical decisions.
- Evaluates team members, receiving team input and participation to provide timely and specific feedback and counseling, which improves performance and staff development, conforming with regional policy and procedures. Develops individual goals and action plans for achievement, against established performance standards. Coordinates performance review process with Lead MD and serves as the liaison for input to performance from those outside of the health care team.
- Case management for patients which requires coordination with QRM, other providers, social workers, community and other alternative care interventions.
- Documents patient history and interventions, using computerized and electronic systems and processes to optimize patient care delivery.
- Ensures customer concerns are resolved by self and the team, integrating changes to meet customer needs.
- Demonstrates excellent clinical knowledge and judgment, incorporating continuous learning for self and the team that enhances delivery of care and maintains clinical competence.
- Values diversity, fostering respect, appreciation, and inclusion of diversity within the team and in the delivery of culturally sensitive care.
- Maintains productive partnerships with Chiefs of Service, Directors, Labor Partners, Facility Leadership and Staff to achieve business and labor management partnership business imperatives.
- Collaborates with clinical educators in identifying and meeting the educational requirements of the team, ensuring incorporation.
- Models and reinforces ethical behavior in self and others in accordance to the Principles of Responsibility; adheres to organizational policies and guidelines; supports compliance initiatives; maintains confidences; admits mistakes; conducts business with honesty; shows consistency in words and actions; follows through on commitments. Applicable federal, state and local laws, rules and regulations and applicable accreditation standard.
- Manages systems and processes that support patient flow and care provided by the practitioners.
- Partner with clinical education department for on-boarding and orientation of new employees to ensure competency validation within the first 90 days of employment as well as ongoing competency and clinical quality.
- Ongoing real time observation of staff clinical competency with annual validation to ensure nursing quality is consistently meeting and exceeding established guidelines and standards.
- Ensures that regulatory and compliance standards are met to include: DHR, QI, EHS, HIPAA, NCQA and HEDIS.
- In collaboration with Health Ed, Nutrition, coordinate appropriate services and their availability to the patient panel meeting their needs as driven by patient data.
- Provide support and back-up to Dir, Specialty Care Ops and functions in the absence of the Dir, Specialty Care Operations.
- May perform other duties as assigned.
- Minimum seven (7) years of clinical specialty and/or ambulatory experience.
- Minimum five (5) years of supervisory/leadership experience.
- Bachelor's of Science Nursing.
License, Certification, Registration
- Current licensure as a Registered Professional Nurse in the State of Georgia or able to obtain prior to date of hire.
- Current Basic Life Support (BLS) certification from the American Heart Association must be obtained prior to hire date.
- Demonstrated strong clinical knowledge base and judgment, preferably in an ambulatory/ER care setting.
- Experience in managing patients and families with complex medical, psycho/social problems.
- Knowledge of adult learning theory and experience in teaching/education Ability to analyze, integrate, and use quantitative data information in making business decisions and problem solving.
- Ability to establish and manage budgets and capitated agreements.
- Complete a Customer Service Assessment.
- Customer service aptitude demonstrated through Customer Service Assessment.
- Emergency Room and/ or Ambulatory Care nursing experience and/or supervision.