Director of Clinical Services & Care Management (RN)

Job Description:

The position, Director of Clinical Services, reports directly to the VP of Clinical Services, and provides day-to-day oversight and adherence to all standards and expectations of the Clinical Services teams. It is a 100% Las Vegas office-based position, not eligible for remote or work from home.  

The Company:

This role is with USHS, an Arkos Health Company. Arkos serves health plans and provider organizations an integrated system-of-care comprised of clinical and social services backed by a robust technology platform. By engaging individuals with virtual, in-home, in-clinic and in-facility care options, Arkos Health delivers advanced community-based health services that allow our clients to live healthier, more independent lives.

Essential Duties and Responsibilities:

• Provides supervision and guidance through clinical leadership to the care management teams.
• Maintains and ensures the successful process flow of all clinical programs established with our contracted partners.
• Provides oversight and ongoing training to care management clinicians.
• Establish and evaluate operational/staffing criteria for Clinical Service departments including but not limited to Special Needs Population, Complex Care Management, and Hospital/SNF Care Management.
• Interact proactively with network providers/offices to educate on organization services, problem solve and resolve care management/care coordination related issues or concerns.
• Identifies and submits to the VP of Clinical Services any potential quality issues for review.
• Prepares and investigates any quality issues or complaints involving the clinical team.
• Collaborates with the VP of Clinical Services for process improvement and assurance of operational quality as well as, HIPAA compliance according to corporate and compliance policies.
• Conducts weekly audits of care management team cases, to ensure corporate and partner compliance is met.
• Prepares and appropriately delivers weekly Interdisciplinary Care Team agenda and participates in meetings according to contracted standards.
• Maintains and audits weekly time and mileage sheets for all applicable staff.
• Acts as a resource for all clinical staff for any operational or clinical concerns.
• Conducts performance evaluations and formulates disciplinary action plans, as appropriate.
• Participates and equally shares in after-hour and week-end coverage for Clinical Services Department.
• Work with the assigned HR team to conduct recruitment, hiring, and training of required personnel.
• Strong teamwork philosophy and willingness to accept change proactively.

Qualifications/Skills:

• Knowledge of Medicare/Medicaid state, and local managed care regulations.
• Five years acute care or care management experience, prior ER or ICU or other relevant clinical role requiring quick critical thinking experience preferred.
• Must have the ability to present clinical information both accurately and confidently.
• Able to communicate effectively and in a professional manner with all levels of internal staff and external customers.
• Ability to be detail-oriented, able to function under pressure and able to prioritize and re-prioritize tasks as needed.
• Ability to work both independently and as part of a team, with minimal supervision.
• Excellent customer service and communication skills, both oral and written.
• Current unrestricted Nursing license – BSN preferred.
• Prior experience in managed care setting preferred.

Benefits:

• Fully paid employee medical/dental/vision/life/short term disability
• Employer matching 401(k)
• 15 days annual combined sick/PTO with 9 paid holidays
  

Must complete our Culture Index Survey. Take the assessment at https://portal.cultureindex.com/public/survey/general/bg3VS0H2kF.  This is not a pass/fail test and does not measure intelligence.

Arkos Health EEO Statement

All Arkos Health divisions are Equal Opportunity Employers. We do not discriminate on the basis of race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status or any other status protected under federal, state or local laws.

Arkos Health is a drug free workplace. All job applicants selected for employment are required to submit to a pre-employment drug test and background check.