Description
In this role, you will play a vital part in evaluating and overseeing health maintenance and promotion programs. Your leadership will ensure that clinical programs meet the needs of our members while achieving contractual compliance and clinical, quality, and utilization management goals. You will help develop capabilities and refine processes to effectively grow and manage the Clinical Operations team, facilitating the successful implementation of clinical programs, vendor relationships, and technology-enabled health initiatives.
Collaboration is key, as you will work closely with the Market Operations team and report to the Director of Nursing and Clinical Operations. You will oversee a team that includes Nurse Care Managers and partner with Social Workers, Care Coordinators, and Transition of Care Coordinators. Your collaboration with physician leaders will be essential for the overall success of our market and team operations.
This position is remote; however, candidates should be located within or near the Albany market for in-person meetings and visits to physician offices and healthcare facilities as needed.
Primary Functions Include
- Provide both direct and indirect oversight of interdisciplinary care teams, including Nurse Care Managers, Social Workers, Care Coordinators, and Transition of Care Coordinators.
- Monitor clinical and business dashboards/metrics that impact patient outcomes and team performance.
- Understand HEDIS measures and assist in developing plans to address any gaps.
- Manage complaints and grievances, ensuring timely responses and promoting optimal patient and partner satisfaction.
- Oversee processes for managing internal and external referrals for healthcare services, including behavioral health, home health, and specialist referrals.
- Foster cohesive team dynamics to ensure success while leveraging key performance indicators.
- Manage the direct admit process to skilled nursing facilities, ensuring appropriate criteria and medical documentation are met in collaboration with the medical team.
- Participate in the interview process and work alongside recruiters to hire new team members.
- Conduct performance reviews, set individual goals, and mentor team members for professional growth.
- Collaborate to develop innovative solutions and programs to overcome healthcare barriers.
- Work closely with market leaders to facilitate team member education and onboarding, identifying their needs for knowledge, skills, and abilities.
- Perform other related responsibilities as assigned.
How You Qualify
If you resonate with our innovative culture and are eager to contribute, you might be the perfect fit!
- Must have reliable access to high-speed internet for seamless remote communication and productivity.
- Degree from an accredited nursing program, with a minimum of an Associate or Diploma in Nursing required; a Bachelor’s of Science in Nursing is preferred.
- An active, unrestricted Registered Nurse license is required.
- A minimum of 2 years of continuous hospital clinical experience within the past 10 years is required.
- At least 2 years of continuous ambulatory clinical experience within the past 5 years is required, preferably in care management or practice management.
- Experience in using data to drive strategy and execution.
- Proven ability to implement clinical programs with demonstrated results.
- Proficient in Microsoft Office products (e.g., Outlook, Teams, Excel, PowerPoint).
- Experience in managing interdisciplinary teams and facilitating team discussions.
- Experience in home healthcare, health plans, or hospice is preferred.
- Expertise in Performance Improvement is preferred.
- Must be able to arrange travel to various work sites as needed, and possess a valid driver’s license and motor vehicle insurance.
Compensation And Benefits
The base pay range for this role is \(94,300 - \)108,400, with compensation considering factors such as experience, education, skills, licensure, certifications, and organizational needs. This base pay is just one part of a comprehensive rewards program that includes eligibility for short-term incentives and a rich benefits package.
As a full-time team member, you will enjoy an exceptional total rewards package, including competitive base pay with bonuses, starting at 4 weeks of paid time off, 12 paid holidays per year, reimbursement for continuing medical education, a 401k plan with matching, and health, dental, and vision insurance.
Our family-friendly policies support paid parental leave and flexible work arrangements. You will also benefit from a robust commitment to training and development that starts with onboarding and continues throughout your career. You will collaborate with like-minded healthcare professionals who understand the importance of delivering high-quality, value-based care.
Employment Type: Full-Time