Clinical Operations, Manager

Job Summary and Responsibilities

Acentra seeks a Clinical Operations, Manager - RN to join our growing team.

Job Summary:

The supervision and day-to-day activities of the assigned Case Review Teams. Mentoring, coaching, and training team members in the case review process to ensure quality and contract deliverables are met. Using independent judgment, utilizing clinical knowledge and competence, communication skills, problem-solving and conflict resolution to effectively ensure optimal client outcomes with consideration of payer/client requirements. Working effectively with all healthcare team members internally and externally. Supporting the interdisciplinary team with the underlying objective of ensuring contractual, regulatory, and accreditation compliance, and providing timely and accurate data and communications.

***Position is remote***

** Required Work Hours: Monday - Friday from 9:00 AM - 5:30 PM EST. **

** Occasionally, work may be required in the evenings, holidays and on weekends. **

Job Responsibilities:

Supervise, mentor, coach, and develop the case review team in the clinical area of case review and dispute resolution, ensure a high level of clinical knowledge and performance by the clinical team. Fosters a caring philosophy in leadership and all aspects of the case review process.
Oversee teamwork assignments, assess, evaluate, and address workload; adjust to meet the demands of the department and contract requirements; measure results and initiate personnel actions as required. Applies a comprehensive knowledge of case review and caring concepts to all aspects of assignments.
Develop case review staff, identify orientation and continuous learning needs in collaboration with direct leadership, and develop and implement plans to address those learning needs.
Responsible for quality monitoring activities, including identifying areas of improvement for individual team members, processes, and quality improvement initiatives. Ensures compliance with regulatory and accreditation standards and contractual service level agreements.
Participates in developing, implementing, evaluating, and revising, case review tools that specifically support case review programs.
Maintains open communication with all appropriate parties and facilitates communication to/between members of the care team; ensures accurate and timely documentation and reporting.
Maintains strict standards for client confidentially and client-related information; complies with all organizational, state, and federal regulations and policies on confidentially.
Participates as a leadership team in all contract management activities as well as contract administration deliverables.
Performs other duties as related to case review supervision functions as needed.
Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

Qualifications

Required Qualifications/Experience:

Active, unrestricted RN licensure.
Requires pursuing ongoing education, certification, and self-development to remain current with case review standards.
4+ years of clinical experience in a medical setting.
Quality management experience with projects, reporting outcomes, or other QIP involvement.
Case review experience with evidence-based practice standards.
Knowledge of the No Surprises Act and Dispute Resolution.

Preferred Qualifications/Experience:

Bachelor’s degree in nursing or related nursing field.
Previous workload management experience.
Previous client management experience.
Strong supervisory experience and knowledge; Independent Dispute Resolution recommended.
Strong team-building skills.
Excellent verbal and written communication skills; excellent interpersonal communication and negotiation skills.
Ability to utilize critical thinking and apply sound judgment for decision-making and guiding staff.
Understanding of the importance of instilling a caring philosophy in all aspects of the case review process.
Analytical, reporting, and data management skills.
Strong organizational and time management skills and the capacity to prioritize multiple tasks.
Demonstrates the ability to be organized and efficient in prioritizing and managing assignments with minimal oversight and direction.
Computer proficiency in Microsoft Office and other software programs and the ability to enter and retrieve data from relevant computer systems.