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SR Director/Director Clinical Operations
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Senior Clinical Trials Oncology Consultant
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Medcv Pennsylvania, United StatesOverview · Employed Monday-Friday Outpatient Child Psychiatrist opening outskirts of Pittsburgh, PA. There is an opening for an adult and for a child psychiatrist from the same employer. Must be BE/BC in Psychiatry. Work at 2-3 office location seeing patients Monday-Friday. Exce ...
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Edwards Lifesciences Pennsylvania, United States Full timeMake a meaningful difference to patients around the world. As a part of the Field Clinical Specialist team, you will be a critical part of delivering our patient focused innovations, partnering with clinical professionals, and training them on using our groundbreaking products. Y ...
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Process Engineer
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Radiologic Technologist
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IT Integration Engineer
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Epic Security Analyst
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Teleflex Pennsylvania, United StatesSearch by Keyword Select how often (in days) to receive an alert: Select how often (in days) to receive an alert: Vice President, Global Reimbursement, Healthcare Economics, and Market Access · Date: Jun 3, 2024 · Location: Remote, PA, US · #job- { display: inline; } Com ...
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Bilingual Case Manager
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Primary Care Physicians
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RN Case Manager Personal Cares- Full Time
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Enterprise Medical Recruiting Pennsylvania, United StatesJoin progressive FQHC with 19 offices in Northeastern Pennsylvania. They operate primary care, dental, women?s health, and behavioral health services, along with specialty practices in surgery and neurology. It has more than a dozen outpatient offices across Wayne, Pike, Lackawan ...
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Geriatric Medicine
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RN Case Manager Personal Cares- FT
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Regional Director of Clinical Operations - Pennsylvania, United States - TruHealth
3 weeks ago
Description
As one of our Regional Directors of Clinical Operations you'll manage a team of exceptional clinical program managers who are committed to quality care. This role requires excellent management skills backed by a strong understanding of Medicare, Medicaid and managed care regulations. You will work closely with our nursing home partners to ensure we deliver the highest level of care, while preventing fraud and abuse.
TruHealth is a division of American Health Partners, a multifaceted company with operations in seven states. We own nursing homes, health plans for Medicare beneficiaries living in long-term care facilities, as well as divisions offering psychiatric care, home health, hospice, rehabilitation and specialty pharmacy services. Come grow with us. We offer competitive compensation, generous benefits and advancement opportunities.
POSITION SUMMARY
The Regional Director of Clinical Operations will oversee the market's clinical program managers to support cost-effective, high-quality healthcare for patients enrolled in their long-term care facilities' Medicare Advantage Plan. This position is responsible for monitoring performance metrics, implementing growth initiatives, designing and analyzing local interventions to impact acute utilization.
Essential Job Duties:
To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.
• Directly manage market clinical program managers within designated region
• Collaborate with corporate and facility leadership to meet key performance metrics
• Ensure all patient services are delivered on time and effectively, within the scope of the plan
• Collaborate with colleagues to explore innovative delivery models or enhancements
• Identify opportunities for process improvements and staff education to produce optimal results
• Serve as a subject matter expert (SME) on the ISNP plan and care model
• Assist in the development of training materials to support clinical training; participate in clinical training initiatives
• Collaborate with business leaders to implement new markets and programs
• Review daily, weekly and monthly management reports to monitor and manage care delivery, including market financials as
applicable to staffing and company resource utilization
• Monitor performance metrics
• Implement growth initiatives with the Plan
• Improve service delivery through collaboration with vendors and community organizations
• Oversee the review and resolution of complaints and grievances
• Participate in company-wide initiatives to ensure consistency in the clinical delivery of care
• Participate in company-wide initiatives across all aspects of the organization
• Work with interdepartmental leaders to coordinate care delivery
• Ensure adherence to the model of care
• Anticipate staffing needs; oversee hiring
• Other duties as assigned
Job Requirements
• Ensure care is administered in accordance with Medicare, Medicare Advantage and all other compliance programs, state laws
and regulatory compliance
• Ensure privacy and security; detect, prevent and correct fraud, waste and abuse
• Punctuality, reliability
• Successful completion of required training
• Driver's license without restrictions; clean driving record
• Manage stress appropriately
• Handle multiple priorities effectively
• Independent discretion/decision making
• Make decisions under pressure
• Multi-task, meet deadlines, prioritize
• Position may require flexible hours, unscheduled overtime or occasional week-end work
• Some travel may be required
Required Qualifications
• Education:
o Master's degree in Nursing
• Experience:
o 5 years' experience in business education or healthcare experience required
o 1-3 years of management experience preferred
o Proficient leadership and business skills preferred
o Advanced knowledge of HEDIS/STARs preferred
o Strong background and familiarity with Medicare, Medicaid, I-SNP, nursing facility and managed care desired
• License/Certification(s):
o APRN license optional
